Placenta accreta is a severe pregnancy complication and is currently the most common indication for peripartum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Main risk factor for placenta accreta is a previous cesarean delivery particularly when accompanied with a coexisting placenta previa. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Diagnosis can be achieved by ultrasound in the majority of cases. Women with placenta accreta are usually delivered by a cesarean section. In order to avoid an emergency cesarean and to minimize complications of prematurity it is acceptable to schedule cesarean at 34 to 35 weeks. A multidisciplinary team approach and delivery at a center with adequate resources, including those for massive transfusion are both essential to reduce neonatal and maternal morbidity and mortality. The optimal management after delivery of the neonate is vague since randomized controlled trials and large cohort studies are lacking. Cesarean hysterectomy is probably the preferable treatment. In carefully selected cases, when fertility is desired, conservative management may be considered with caution. The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition. 1. Introduction Placenta accreta occurs when the chorionic villi invade the myometrium abnormally. It is divided into three grades based on histopathology: placenta accreta where the chorionic villi are in contact with the myometrium, placenta increta where the chorionic villi invade the myometrium, and placenta percreta where the chorionic villi penetrate the uterine serosa [1]. Placenta accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage [2]. It has become the leading cause of emergency hysterectomy [3]. Maternal morbidity had been reported to occur in up to 60% and mortality in up to 7% of women with placenta accreta. In addition, the incidence of perinatal complications is also increased mainly due to preterm birth and small for gestational age fetuses [4–7]. Once a rare occurrence, placenta accreta is becoming an increasingly common complication of pregnancy, mainly due to the increasing rate of cesarean delivery over the past 50 years [8]. In view of the fact that the indications for cesarean delivery seem to be steadily expanding, including cesarean delivery on
References
[1]
C. H. Tan, K. H. Tay, K. Sheah et al., “Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta,” American Journal of Roentgenology, vol. 189, no. 5, pp. 1158–1163, 2007.
[2]
R. Faranesh, R. Shabtai, S. Eliezer, and S. Raed, “Suggested approach for management of placenta percreta invading the urinary bladder,” Obstetrics and Gynecology, vol. 110, no. 2, pp. 512–515, 2007.
[3]
G. Daskalakis, E. Anastasakis, N. Papantoniou, S. Mesogitis, M. Theodora, and A. Antsaklis, “Emergency obstetric hysterectomy,” Acta Obstetricia et Gynecologica Scandinavica, vol. 86, no. 2, pp. 223–227, 2007.
[4]
L. Hudon, M. A. Belfort, and D. R. Broome, “Diagnosis and management of placenta percreta: a review,” Obstetrical and Gynecological Survey, vol. 53, no. 8, pp. 509–517, 1998.
[5]
J. M. O'Brien, J. R. Barton, and E. S. Donaldson, “The management of placenta percreta: conservative and operative strategies,” American Journal of Obstetrics and Gynecology, vol. 175, no. 6, pp. 1632–1638, 1996.
[6]
S. Sumigama, A. Itakura, T. Ota et al., “Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course,” Journal of Obstetrics and Gynaecology Research, vol. 33, no. 5, pp. 606–611, 2007.
[7]
A. G. Eller, T. T. Porter, P. Soisson, and R. M. Silver, “Optimal management strategies for placenta accreta,” An International Journal of Obstetrics and Gynaecology, vol. 116, no. 5, pp. 648–654, 2009.
[8]
B. E. Hamilton, J. A. Martin, S. J. Ventura, P. D. Sutton, and F. Menacker, “Births: preliminary data for 2004,” National vital Statistics Reports, vol. 54, no. 8, pp. 1–17, 2005.
[9]
C. R. Warshak, G. A. Ramos, R. Eskander et al., “Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta,” Obstetrics and Gynecology, vol. 115, no. 1, pp. 65–69, 2010.
[10]
S. Wu, M. Kocherginsky, and J. U. Hibbard, “Abnormal placentation: twenty-year analysis,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1458–1461, 2005.
[11]
D. A. Miller, J. A. Chollet, and T. M. Goodwin, “Clinical risk factors for placenta previa-placenta accreta,” American Journal of Obstetrics and Gynecology, vol. 177, no. 1, pp. 210–214, 1997.
[12]
S. L. Clark, P. P. Koonings, and J. P. Phelan, “Placenta previa/accreta and prior cesarean section,” Obstetrics and Gynecology, vol. 66, no. 1, pp. 89–92, 1985.
[13]
Y. Gielchinsky, N. Rojansky, S. J. Fasouliotis, and Y. Ezra, “Placenta accreta—summary of 10 years: a survey of 310 cases,” Placenta, vol. 23, no. 2-3, pp. 210–214, 2002.
[14]
E. Sivan, M. Spira, R. Achiron et al., “Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy?” American Journal of Perinatology, vol. 27, no. 6, pp. 455–461, 2010.
[15]
G. Garmi, S. Goldman, E. Shalev, and R. Salim, “The effects of decidual injury on the invasion potential of trophoblastic cells,” Obstetrics and Gynecology, vol. 117, no. 1, pp. 55–59, 2011.
[16]
P. Tantbirojn, C. P. Crum, and M. M. Parast, “Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast,” Placenta, vol. 29, no. 7, pp. 639–645, 2008.
[17]
F. Alkazaleh, M. Geary, J. Kingdom, J. R. Kachura, and R. Windrim, “Elective non-removal of the placenta and prophylactic uterine artery embolization postpartum as a diagnostic imaging approach for the management of placenta percreta: a case report,” Journal of Obstetrics and Gynaecology Canada, vol. 26, no. 8, pp. 743–746, 2004.
[18]
Committee on Obstetric Practice American College of Obstetricians and Gynecologists, “ACOG committee opinion. Placenta accreta. Number 266, January 2002,” International Journal of Gynecology and Obstetrics, vol. 77, no. 1, pp. 77–78, 2002.
[19]
Y. Oyelese and J. C. Smulian, “Placenta previa, placenta accreta, and vasa previa,” Obstetrics and Gynecology, vol. 107, no. 4, pp. 927–941, 2006.
[20]
G. Kayem, C. Davy, F. Goffinet, C. Thomas, D. Cléent, and D. Cabrol, “Conservative versus extirpative management in cases of placenta accreta,” Obstetrics and Gynecology, vol. 104, no. 3, pp. 531–536, 2004.
[21]
S. Timmermans, A. C. Van Hof, and J. J. Duvekot, “Conservative management of abnormally invasive placentation,” Obstetrical and Gynecological Survey, vol. 62, no. 8, pp. 529–539, 2007.
[22]
T. H. Hung, W. Y. Shau, C. C. Hsieh, T. H. Chiu, J. J. Hsu, and T. T. Hsieh, “Risk factors for placenta accreta,” Obstetrics and Gynecology, vol. 93, no. 4, pp. 545–550, 1999.
[23]
R. Washecka and A. Behling, “Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature,” Hawaii Medical Journal, vol. 61, no. 4, pp. 66–69, 2002.
[24]
C. A. Armstrong, S. Harding, T. Matthews, and J. E. Dickinson, “Is placenta accreta catching up with us?” Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 44, no. 3, pp. 210–213, 2004.
[25]
M. Alanis, B. S. Hurst, P. B. Marshburn, and M. L. Matthews, “Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in a favorable outcome in subsequent pregnancies,” Fertility and Sterility, vol. 86, no. 5, pp. 1514.e3–1514.e7, 2006.
[26]
K. Benirschke, P. Kaufmann, and R. N. Baergen, Pathology of the Human Placenta, Springer, New York, NY, USA, 5th edition, 2006.
[27]
J.-J. Tseng and M.-M. Chou, “Differential expression of growth-, angiogenesis- and invasion-related factors in the development of placenta accreta,” Taiwanese Journal of Obstetrics and Gynecology, vol. 45, no. 2, pp. 100–106, 2006.
[28]
M. Cohen, C. Wuillemin, O. Irion, and P. Bischof, “Role of decidua in trophoblastic invasion,” Neuroendocrinology Letters, vol. 31, no. 2, pp. 193–197, 2010.
[29]
U. Earl, J. N. Bulmer, and A. Briones, “Placenta accreta: an immunohistological study of trophoblast populations,” Placenta, vol. 8, no. 3, pp. 273–282, 1987.
[30]
C. H. Comstock, “Antenatal diagnosis of placenta accreta: a review,” Ultrasound in Obstetrics and Gynecology, vol. 26, no. 1, pp. 89–96, 2005.
[31]
M. A. Belfort, “Placenta accrete,” American Journal of Obstetrics & Gynecology, vol. 203, pp. 430–439, 2010.
[32]
H. S. Wong, K. C. Ying, J. Zuccollo, J. Tait, and K. C. Pringle, “Evaluation of sonographic diagnostic criteria for placenta accreta,” Journal of Clinical Ultrasound, vol. 36, no. 9, pp. 551–559, 2008.
[33]
J. C. Shih, J. M.P. Jaraquemada, Y. N. Su et al., “Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques,” Ultrasound in Obstetrics and Gynecology, vol. 33, no. 2, pp. 193–203, 2009.
[34]
D. Levine, C. A. Hulka, J. Ludmir, W. Li, and R. R. Edelman, “Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging,” Radiology, vol. 205, no. 3, pp. 773–776, 1997.
[35]
C. Zelop, A. Nadel, F. D. Frigoletto, S. Pauker, M. MacMillan, and B. R. Benacerraf, “Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein,” Obstetrics and Gynecology, vol. 80, no. 4, pp. 693–694, 1992.
[36]
C. Mazouni, G. Gorincour, V. Juhan, and F. Bretelle, “Placenta accreta: a review of current advances in prenatal diagnosis,” Placenta, vol. 28, no. 7, pp. 599–603, 2007.
[37]
P. Tantbirojn, C. P. Crum, and M. M. Parast, “Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast,” Placenta, vol. 29, no. 7, pp. 639–645, 2008.
[38]
A. G. Eller, M. A. Bennett, M. Sharshiner et al., “Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care,” Obstetrics and Gynecology, vol. 117, no. 2, pp. 331–337, 2011.
[39]
B. K. Robinson and W. A. Grobman, “Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta,” Obstetrics and Gynecology, vol. 116, no. 4, pp. 835–842, 2010.
[40]
J. L. Hawkins, J. F. Arens, B. A. Bucklin et al., “Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on obstetric anesthesia,” Anesthesiology, vol. 106, no. 4, pp. 843–863, 2007.
[41]
D. H. Chestnut, D. M. Dewan, L. F. Redick, D. Caton, and F. J. Spielman, “Anesthetic management for obstetric hysterectomy: a multi-institutional study,” Anesthesiology, vol. 70, no. 4, pp. 607–610, 1989.
[42]
K. M. Kuczkowski, “Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know?” Archives of Gynecology and Obstetrics, vol. 273, no. 6, pp. 319–321, 2006.
[43]
A. G. Eller, T. T. Porter, P. Soisson, and R. M. Silver, “Optimal management strategies for placenta accreta,” An International Journal of Obstetrics and Gynaecology, vol. 116, no. 5, pp. 648–654, 2009.
[44]
J. A. Read, D. B. Cotton, and F. C. Miller, “Placenta accreta: changing clinical aspects and outcome,” Obstetrics and Gynecology, vol. 56, no. 1, pp. 31–34, 1980.
[45]
E. Clouqueur, C. Rubod, A. Paquin, L. Devisme, and P. Deruelle, “Placenta accreta: diagnosis and management in a French high-level maternity,” Journal de Gynecologie Obstetrique et Biologie de la Reproduction, vol. 37, no. 5, pp. 499–504, 2008.
[46]
G. Kayem, C. Davy, F. Goffinet, C. Thomas, D. Cléent, and D. Cabrol, “Conservative versus extirpative management in cases of placenta accreta,” Obstetrics and Gynecology, vol. 104, no. 3, pp. 531–536, 2004.
[47]
A. Weinstein, P. Chandra, H. Schiavello, and A. Fleischer, “Conservative management of placenta previa percreta in a Jehovah's Witness,” Obstetrics and Gynecology, vol. 105, no. 5, pp. 1247–1250, 2005.
[48]
W. Henrich, I. Fuchs, T. Ehrenstein, S. Kjos, A. Schmider, and J. W. Dudenhausen, “Antenatal diagnosis of placenta percreta with planned in situ retention and methotrexate therapy in a woman infected with HIV,” Ultrasound in Obstetrics and Gynecology, vol. 20, no. 1, pp. 90–93, 2002.
[49]
L. Sentilhes, C. Ambroselli, G. Kayem et al., “Maternal outcome after conservative treatment of placenta accreta,” Obstetrics and Gynecology, vol. 115, no. 3, pp. 526–534, 2010.
[50]
L. Sentilhes, G. Kayem, C. Ambroselli et al., “Fertility and pregnancy outcomes following conservative treatment for placenta accreta,” Human Reproduction, vol. 25, no. 11, pp. 2803–2810, 2010.
[51]
J. D. Paull, J. Smith, L. Williams, G. Davison, T. Devine, and M. Holt, “Balloon occlusion of the abdominal aorta during caesarean hysterectomy for placenta percreta,” Anaesthesia and Intensive Care, vol. 23, no. 6, pp. 731–734, 1995.
[52]
R. Salim, N. Zafran, A. Chulski, and E. Shalev, “Employing a balloon catheter for occlusion and/or embolization of the pelvic vasculature as an adjuvant therapy in cases of abnormal placentation,” Harefuah, vol. 149, no. 6, pp. 370–403, 2010.
[53]
J. Dubois, L. Garel, A. Grignon, M. Lemay, and L. Leduc, “Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses,” American Journal of Obstetrics and Gynecology, vol. 176, no. 3, pp. 723–726, 1997.
[54]
M. M. Chou, J. I. Hwang, J. J. Tseng, and E. S. C. Ho, “Internal iliac artery embolization before hysterectomy for placenta accreta,” Journal of Vascular and Interventional Radiology, vol. 14, no. 9, pp. 1195–1199, 2003.
[55]
D. D. Kidney, A. M. Nguyen, D. Ahdoot, D. Bickmore, L. S. Deutsch, and C. Majors, “Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation,” American Journal of Roentgenology, vol. 176, no. 6, pp. 1521–1524, 2001.
[56]
L. J. Bodner, J. L. Nosher, C. Gribbin, R. L. Siegel, S. Beale, and W. Scorza, “Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta,” CardioVascular and Interventional Radiology, vol. 29, no. 3, pp. 354–361, 2006.
[57]
V. Shrivastava, M. Nageotte, C. Major, M. Haydon, and D. Wing, “Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta,” American Journal of Obstetrics and Gynecology, vol. 197, no. 4, pp. 402.e1–402.e5, 2007.
[58]
M. Mok, B. Heidemann, K. Dundas, I. Gillespie, and V. Clark, “Interventional radiology in women with suspected placenta accreta undergoing caesarean section,” International Journal of Obstetric Anesthesia, vol. 17, no. 3, pp. 255–261, 2008.
