Title

Prenatal sonographic diagnosis of placenta accreta--impact on maternal and neonatal outcomes.

Document Type

Article

Publication Date

10-1-2014

Institution/Department

Pathology, MMCRI, Obstetrics & Gynecology

Journal Title

Journal of clinical ultrasound : JCU

MeSH Headings

Adult, Female, Follow-Up Studies, Humans, Infant, Newborn, Male, Placenta Accreta, Pregnancy, Pregnancy Outcome, Retrospective Studies, Risk Factors, Time Factors, Ultrasonography, Prenatal

ISSN

1097-0096

Abstract

PURPOSE: To compare maternal and neonatal outcomes of prenatally diagnosed versus undiagnosed cases of placenta accreta.

METHODS: This retrospective study included all pathology-proven placentas accreta/increta/percreta from a single tertiary center from January 1, 2005 to December 31, 2012. Outcomes were compared between prenatally diagnosed and undiagnosed cases.

RESULTS: Thirty-six cases of abnormal implantations were identified, of which 19 (53%) were prenatally diagnosed by ultrasound. Prenatal detection was more likely with a percreta (7/19 versus 2/17, p = .07), parity (18/19 versus 9/17, p = .01), prior cesarean (17/19 versus 4/17, p = .0001), shorter cesarean-conception interval (22.8 ± 21.4 versus 108 ± 7.6 months, p = .01), and spontaneous conception (19/19 versus 12/17, p = .03). Cases diagnosed prenatally more frequently received steroids for fetal maturity (13/20 versus 3/19, p = .003), delivered by cesarean (19/19 versus 11/17, p = .01) under general anesthesia (14/19 versus 4/17, p = .002) with a cell saver (5/19 versus 0/17, p = .06). There were no statistically significant differences by group in maternal blood loss, transfusion, intensive care admission or length of stay, operative injury, or severe composite morbidity (reoperation, coagulopathy, thromboembolism, wound infection, multiorgan failure, transfusion reaction, fistula, or chest compressions). There were no statistically significant differences in 5-minute Apgar

CONCLUSION: Prenatally undiagnosed accretas are less complex than prenatally diagnosed cases, but associated with statistically similar outcomes, suggesting benefit to prenatal recognition.

First Page

449

Last Page

455

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