Management of placenta accreta

Abstract

Cesarean hysterectomy is considered the reference standard treatment for placenta accreta. In young women who want the option of future pregnancy and agree to close follow-up monitoring, conservative treatment is a valid option. Several key points of both cesarean hysterectomy and conservative treatment remain debatable, such as timing of delivery, attempted removal of the placenta, use of temporal internal iliac occlusion balloon catheters, ureteral stents, prophylactic embolization, and methotrexate. In cases of placenta percreta with bladder involvement, conservative treatment may be the optimal management. Regardless of the chosen option, the woman and her partner should be warned of the high risk of maternal complications related to an abnormally invasive placenta.

Keywords: Abnormally invasive placenta; antenatal diagnosis; cesarean hysterectomy; conservative treatment; management; placenta accreta or percreta.

© 2013 Nordic Federation of Societies of Obstetrics and Gynecology.