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Medline ® Abstract for Reference 12

of 'Anesthesia for the patient with peripartum hemorrhage'

Comparison between emergent and elective delivery in women with placenta accreta.
Pri-Paz S, Fuchs KM, Gaddipati S, Lu YS, Wright JD, Devine PC
J Matern Fetal Neonatal Med. 2013 Jul;26(10):1007-11. Epub 2013 Feb 14.
OBJECTIVE: To identify possible predictive factors associated with emergent delivery of antenatally diagnosed placenta accreta and to estimate association between emergent delivery and adverse maternal outcomes in comparison to elective delivery.
METHODS: A retrospective study of all patients with placenta accreta diagnosed antenatally and confirmed pathologically, who were delivered between 2000 and 2010. Baseline characteristics and outcomes of emergent deliveries were compared with elective deliveries.
RESULTS: A total of 48 women met inclusion criteria, of which 24 (50%) were delivered emergently. 79.2% of emergent deliveries were preceded by antenatal bleeding (p = 0.0005), and 62.5% were preceded by recurrent bleeding (p = 0.001). Comparison of elective and emergent deliveries revealed no clinical significant difference in maternal outcome.
CONCLUSIONS: Antenatal bleeding is associatedwith an increased risk of emergent delivery. Emergent delivery in a tertiary care facility with immediate access to blood bank and ICU capabilities does not appear to be associated with an increased risk of adverse maternal outcomes. Consequently, some patients may be candidates for delivery later than 34 weeks of gestation.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA. smp9009@med.cornell.edu