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The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study
Open accessAbstract
Objective: To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. Design: A population‐based descriptive study using the UK O bstetric S urveillance S ystem (UKOSS). Setting: All 221 UK hospitals with obstetrician‐led maternity units. Population: All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Methods: Prospective case identification through the monthly mailing of UKOSS. Main outcome measures: Median estimated blood loss, transfusion requirements. Results: A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Conclusions: Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.
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“PAS becomes a clinical problem after birth, when the placenta does not physiologically detach from the uterus and the forcible removal of the placenta is followed by massive obstetric haemorrhage (MOH), leading to further morbidity and risk of maternal death.”
From Placenta accreta spectrum – variations in clinical practice and maternal morbidity between the UK and France: a population‐based comparative study (2022) · cites this paper as [3]
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Baldwin, H., Nippita, T. A. C., Torvaldsen, S., Ibiebele, I., Ford, J. B., & Patterson, J. A. (2020) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004051 · Cited by 29
Performance of antenatal imaging to predict placenta accreta spectrum degree of severity
Morel, O., van Beekhuizen, H. J., Braun, T., Collins, S., Pateisky, P., Calda, P., Henrich, W., Naimi, A. A., Nørgaard, L. N., Chalubinski, K. M., et al. (2021) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14112 · Cited by 29
Hessami, K., Salmanian, B., Einerson, B. D., Carusi, D. A., Shamshirsaz, A. A., Shainker, S. A., Subramaniam, A., Shrivastava, V. K., Nieto‐Calvache, A. J., Gilner, J. B., et al. (2022) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004923 · Cited by 34
Shorter the cervix, more difficult the placenta percreta operations
Polat, M., Kahramanoğlu, İ., Şenol, T., Özkaya, E., & Karateke, A. (2015) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2015.1085017 · Cited by 28
Cost Savings of Red Cell Salvage During Cesarean Delivery
Albright, C. M., Rouse, D. J., & Werner, E. F. (2014) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000000465 · Cited by 26
Angileri, S. A., Mailli, L., Raspanti, C., Ierardi, A. M., Carrafiello, G., & Belli, A. (2017) · La radiologia medica · doi:10.1007/s11547-017-0777-z · Cited by 27
Placenta accreta spectrum disorders - Peri-operative management: The role of the anaesthetist
Hawkins, R., Evans, M., Hammond, S., Hartopp, R., & Evans, E. (2020) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2020.08.003 · Cited by 26
The recurrence risk of placenta accreta following uterine conserving management
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Pathologically Diagnosed Placenta Accreta and Hemorrhagic Morbidity in a Subsequent Pregnancy
Roeca, C. M., Little, S. E., & Carusi, D. A. (2017) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000001843 · Cited by 25
Shmakov, R. G., Vinitskiy, A. A., Chuprinin, V. D., Львовна, Я. Е., & Sukhikh, G. T. (2018) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1424821 · Cited by 25
Mei, Y., Zhao, H., Zhou, H., Jing, H., & Lin, Y. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2303-x · Cited by 26
Patient selection for later delivery timing with suspected previa‐accreta
Perlman, N. C., Little, S. E., Thomas, A., Cantonwine, D. E., & Carusi, D. A. (2017) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13140 · Cited by 24
Bartels, H. C., Mulligan, K. M., Lalor, J., Higgins, M., & Brennan, D. J. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.09.014 · Cited by 24
Quality of life and sexual function after a pregnancy complicated by placenta accreta spectrum
Bartels, H. C., Terlizzi, K., Cooney, N., Kranidi, A., Cronin, M., Lalor, J., & Brennan, D. J. (2021) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.13338 · Cited by 24
Geisler, H. C., Safford, H. C., & Mitchell, M. J. (2023) · Small · doi:10.1002/smll.202300852 · Cited by 24
MRI of placenta percreta: differentiation from other entities of placental adhesive disorder
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Petrov, D. A., Karlberg, B., Singh, K., Hartman, M. S., & Mittal, P. (2017) · Current Problems in Diagnostic Radiology · doi:10.1067/j.cpradiol.2017.10.010 · Cited by 24
Miyakoshi, K., Otani, T., Kondoh, E., Makino, S., Tanaka, M., & Takeda, S. (2017) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.12397 · Cited by 24
Prospective First‐Trimester Ultrasound Imaging of Low Implantation and Placenta Accreta Spectrum
Happe, S. K., Rac, M. W. F., Moschos, E., Wells, C. E., Dashe, J. S., McIntire, D. D., & Twickler, D. M. (2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15295 · Cited by 24
Alanwar, A., El-Sayed, H. M., Ibrahim, A., Elkotb, A. M., Abdelshafy, A., Abdelhadi, R. A. , Abbas, A. M., Abdelmenam, H. S., Fares, T., Nossair, W. S., et al. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1408069 · Cited by 24
Retracted“YouTube™ as a source of information on placenta accreta: A quality analysis”
Ruvolo, C. C., Califano, G., Tuccillo, A., Tolentino, S., Cancelliere, E., Bello, F. D., Celentano, G., Creta, M., Longo, N., Morra, S., et al. (2022) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2022.03.015 · Cited by 23
Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging
Faralli, I., Negro, V. D., Chinè, A., Aleksa, N., Ciminello, E., & Piccioni, M. G. (2022) · Diagnostics · doi:10.3390/diagnostics12112769 · Cited by 23
Melekoğlu, R., Çelik, E., Eraslan, S., & Büyükkurt, S. (2016) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.13215 · Cited by 22
Sargent, W., & Collins, S. L. (2019) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13487 · Cited by 21
Gelany, S. E., Ibrahim, E. M., Mohammed, M., Abdelraheim, A. R., Khalifa, E. M., Abdelhakium, A. K., Yousef, A. M., Hassan, H., Goma, K., & Khairy, M. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2244-4 · Cited by 21
Lipkind, H. S., Zuckerwise, L. C., Turner, E. B., Collins, J., Campbell, K. H., Reddy, U., Illuzzi, J. L., & Merriam, A. (2019) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.15818 · Cited by 21
Ou, J., Peng, P., Teng, L., Li, C., & Liu, X. (2019) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2019.09.014 · Cited by 21
Metadata
- Authors
- Fitzpatrick, K., Sellers, S., Spark, P., Kurinczuk, J., Brocklehurst, P., & Knight, M.
- Affiliations
- University of Oxford (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- National Perinatal Epidemiology Unit University of Oxford Oxford UK
- University College London (GB)
- Corresponding author
- Fitzpatrick, KE
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2013-08-07
- Volume
- 121
- Issue
- 1
- Pages
- 62-71
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC3906842
- OpenAlex
- W2024611038
- Cited by
- 357
- References
- 16
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 23 · 2023: 28 · 2022: 30 · 2021: 48 · 2020: 39 · 2019: 28 · 2018: 36 · 2017: 32 · 2016: 19 · 2015: 18 · 2014: 14 · 2013: 4
- FWCI
- 17.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc)
- Funders
- National Institute for Health and Care Research (RP-PG-0608-10038)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Hematology › Blood transfusion and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- placenta accreta, placenta increta, placenta percreta, prenatal diagnosis, uterine preservation, hysterectomy, obstetric hemorrhage, blood transfusion, estimated blood loss, placenta removal, UK Obstetric Surveillance System
- MeSH terms
- Blood Transfusion, Cesarean Section, Ergonovine, Female, United Kingdom, Postpartum Hemorrhage, Humans, Hysterectomy, Oxytocics, Oxytocin, Placenta Accreta, Pregnancy, Prospective Studies, Dinoprost, Cohort Studies, Misoprostol, Treatment Outcome, Uterine Artery Embolization
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