Management of the morbidly adherent placenta (placenta accreta, increta, and percreta)
- Robert Resnik, MD
Robert Resnik, MD
- Professor of Reproductive Medicine
- UCSD School of Medicine
- Robert M Silver, MD
Robert M Silver, MD
- Professor of Obstetrics and Gynecology
- University of Utah School of Medicine
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Management of patients with a morbidly adherent placenta (placenta accreta, increta, or percreta) varies widely in the United States [1,2]. Although the impact of a morbidly adherent placenta on pregnancy outcomes is well-described, no randomized trials and few studies have examined the management of pregnancies complicated by this disorder. As a result, recommendations for its management are based on case series and reports, personal experience, expert opinion, and good clinical judgment.
The management of placenta accreta, increta, and percreta will be discussed here and is essentially the same, except when a percreta extends to extrauterine tissue. Unless otherwise noted, the following discussion of management of placenta accreta applies to all depths of placental invasion. The clinical features and diagnosis of the morbidly adherent placenta are reviewed separately. (See "Clinical features and diagnosis of the morbidly adherent placenta (placenta accreta, increta, and percreta)".)
All patients with suspected placenta accreta should be counseled about the diagnosis and potential sequelae (eg, hemorrhage, blood transfusion, cesarean hysterectomy, maternal intensive care unit admission). Consultation with a maternal-fetal medicine specialist is desirable, and transfer to a center of excellence for placenta accreta is strongly advised.
For patients with placenta previa-accreta, prenatal care follows typical guidelines for management of placenta previa (see "Management of placenta previa"):
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- PRENATAL CARE
- PREPARATION FOR DELIVERY
- Components of preoperative planning
- Balloon catheterization and arterial embolization
- Surgical principles
- - Cesarean hysterectomy
- - Management of placenta percreta with bladder invasion
- CONSERVATIVE MANAGEMENT OF PLACENTA ACCRETA
- Uterine conservation with the placenta left in situ
- Uterine conservation with placental resection
- UNEXPECTED PLACENTA ACCRETA
- POSTOPERATIVE CARE
- SUMMARY AND RECOMMENDATIONS