Conservative versus extirpative management in cases of placenta accreta

OBJECTIVE To compare the impact of conservative and extirpative strategies for placenta accreta on maternal morbidity and mortality. METHODS: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through December 2002. Two consecutive periods, A and B, were compared. During period A (January 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to December 2002), we changed our policy by leaving the placenta in situ. The following outcomes over the 2 periods were compared: need for blood transfusion, hysterectomy, intensive care admission, duration of stay in intensive care, and postpartum endometritis. RESULTS: Thirty-three cases of placenta accreta were observed among 31,921 deliveries (1.03/1,000). During period B, there was a reduction in the hysterectomy rate (from 11 [84.6%] to 3 [15%]; P < .001), the mean number of red blood cells transfused (3,230 2,170 mL versus 1,560 1,646 mL; P < .01), and disseminated intravascular coagulation (5 [38.5%] versus 1 [5.0%]; P = .02), compared with period A. There were 3 cases of sepsis in period B and none in period A (P = .26). At least 2 women with conservative management subsequently had successful pregnancies. CONCLUSION: Leaving the placenta accreta in situ appears to be a safe alternative to removing the placenta. (C) 2004 by The American College of Obstetricians and Gynecologists.