Conservative Versus Extirpative Management in Cases of Placenta Accreta
Abstract
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.
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The approach to conserve the uterus where the placenta is left in situ, either partially or completely, without any attempted removal, is the most common method of conservative management.
“Others have used an approach to conserve the uterus where the placenta is left in situ, either partially or completely, without any attempted removal. 17 , 21 This approach is the most common method of conservative management.”
Previous studies have shown that women had preserved future fertility and reduced haemorrhage risk when PAS was managed conservatively.
“Previous studies have shown that women had preserved future fertility and reduced haemorrhage risk when PAS was managed conservatively.”
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- Authors
- Kayem, G., Davy, C., Goffinet, F., Thomas, C., Clément, D., & Cabrol, D.
- Affiliations
- Hôpital Cochin (FR)
- Venue
- Obstetrics & Gynecology
- Published
- 2004-09
- Volume
- 104
- Issue
- 3
- Pages
- 531-536
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2038841924
- Cited by
- 283
- References
- 21
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 4 · 2020: 12 · 2019: 11 · 2018: 19 · 2017: 15 · 2016: 15 · 2015: 16 · 2014: 10 · 2013: 20 · 2012: 21
- FWCI
- 11.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- placenta accreta, conservative treatment, placenta in situ, manual removal of placenta, hysterectomy, blood transfusion, disseminated intravascular coagulation, postpartum endometritis, maternal morbidity, maternal mortality
- MeSH terms
- Adult, Female, Humans, Hysterectomy, Placenta Accreta, Pregnancy, Retrospective Studies
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