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Management of placenta accreta

The occurrence of placenta accreta is linked to abnormal invasion at the placental implantation site due to a defect within the decidua basalis1. The term increta is used in the case of invasion of the myometrium, while percreta refers to invasion of the serosa or even adjacent organs, most frequently the bladder. Nonetheless, the term accreta is frequently used more generally to cover all three definitions. Placenta accreta is often diagnosed after the baby’s birth, when the placenta fails to deliver. Trying to force this delivery can result in severe postpartum hemorrhage (PPH), emergency hysterectomy and even death. Abnormalities of placental insertion are responsible for 35–38% of peripartum hysterectomies in recent population-based studies2,3. Other potential complications include multiple organ failure, in cases of severe hemorrhage, as well as damage to adjacent organs, such as the bladder. This is particularly true for placenta percreta, for which periand postoperative morbidity is high; a maternal mortality rate of 7% has been reported4. Finally, and more rarely, case reports of percreta describe spontaneous uterine rupture in the second or third trimester of pregnancy, combined with massive hemoperitoneum5–7. Management of placenta accreta involves two principal difficulties: first, its identification, which is aided by risk factor assessment and complementary examinations, and second, its management which strives to reduce maternal complications as much as possible.