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Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 873929, 7 pages
http://dx.doi.org/10.1155/2012/873929
Review Article

Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta

1Department of Obstetrics and Gynecology, Emek Medical Centre, 18101 Afula, Israel
2Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel

Received 24 October 2011; Revised 29 January 2012; Accepted 19 February 2012

Academic Editor: Hong Soo Wong

Copyright © 2012 Gali Garmi and Raed Salim. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.