gynecology and obstetrics
Placenta Accreta
Key Points
In the United States, placenta accreta is becoming increasingly common, occurring most often in women who have placenta previa and have had a cesarean delivery in a previous pregnancy. Consider using periodic ultrasonography to screen women who are > 35 years of age or are multiparous (particularly if placenta previa developed previously or they have had a prior cesarean delivery), who have submucosal fibroids or endometrial lesions, or who have had prior uterine surgery. Suspect placenta accreta if the placenta has not been delivered within 30 minutes of the infant's delivery, if attempts at manual removal cannot create a plane of separation, or if placental traction causes large-volume hemorrhage. If placenta accreta is diagnosed, do cesarean hysterectomy at 34 to 35 6/7 weeks, unless the woman objects. Consider referral to a center with expertise in managing placenta accreta. 