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Mifepristone and Misoprostol for the management of placenta accreta – a new alternative approach

The incidence of morbidly adherent placentas has increased ten-fold in the past 50 years, currently occurring at a frequency of 1 per 1000–2500 deliveries1,2. It is contributing to a large proportion of postpartum hemorrhages (PPH) and has led to some maternal mortalities and several surgical interventions. Current management of morbidly adherent placentas – accreta, increta and especially percreta – reportedly result in a maternal mortality rate of up to 7%, and extensive morbidity due to massive hemorrhage, blood transfusions, infection, ureteral damage and fistula formation3–5. In developing countries, adherent placenta contributed to 13% of maternal deaths6. Traditionally there was a tendency to ensure complete removal of the placental tissue after the delivery to avoid the risk of PPH. This led to a high risk of intervention that sometimes was associated with higher morbidity. In reality, management of adherent placenta should be altered according to the cause of failed delivery of placenta and whether it is associated with PPH. Several options have been developed over recent years for the management of placenta accreta with limited success rates7–16. Recently, the combination of mifepristone/misoprostol was introduced for the treatment of placenta accreta. Both drugs were used over several years for the management of termination of pregnancy with a high success rate to reach complete expulsion of products of conception.