Surgical management of placenta accreta : a six year experience at the King Hussein Medical Centre, Amman, Jordan

Abstract EN

Objectives: The purpose of this study was to report our experiences in the surgical management of suspected placenta accreta.

Methods: This was a retrospective study of all patients with placenta accreta, who underwent a planned delivery, at King Hussein Medical Centre (KHMC), Amman, Jordan, from August 2012 to October 2018.

Included patients’ records were for those with sufficient antenatal history, available radiological and laboratory results and who had an elective delivery.

Demographic characteristics, risk factors, intraoperative and postoperative findings and complications were collected from patient files.

Ultrasound (U/S) and magnetic resonance imaging (MRI) were used for diagnosis and confirmed later by histopathology reports.

All patients’ surgery was performed by a multidisciplinary team.

Results: Eighty patients were identified; all women were multiparous, with one or more previous caesarean section deliveries.

Diagnosis was suspected using U/S, and confirmed by histopathology after surgery.

Twenty women required MRI.

Twenty cases were initially managed conservatively with Bakri balloon, and required secondary hysterectomy because of bleeding.

Ten cases underwent prophylactic internal iliac artery ligation, and four cases were managed by an interventional radiologist, who placed balloon catheters into the common iliac arteries before hysterectomy.

Complications included bladder and ureteric injury, infection, disseminated intravascular coagulation (DIC), intensive care unit (ICU) admission and blood transfusion.

One patient had a vesicovaginal fistula.

The final pathological reports revealed accreta in 58 patients, increta in 18, and percreta in four patients.

Conclusions: Placenta accreta remains a high-risk obstetric condition.

A primary hysterectomy for the management of placenta accrete is the mainstay of care accompanied by an adequate preoperative planning with a multidisciplinary team approach in order to reduce the associated complications.

Conservative treatment should be adopted in highly selected cases after proper counselling about the potential morbidity and failure rate.