Placenta accreta - clinical experience of a tertiary care center over 8 years

• Autor(a) principal: Pinto,Pedro Viana
• Data de Publicação: 2019
• Outros Autores: Guimarães,Susana, Machado,Ana Paula, Montenegro,Nuno
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302019000300002
• topic: Placenta Accreta; Placenta Accreta Spectrum Disorders; Postpartum Haemorrhage; Postpartum Hysterectomy

Overview and aims: Placenta Accreta Spectrum disorders are the leading cause of emergency hysterectomy in developed countries and are associated with high maternal morbidity and mortality (60% and 7%, respectively). The objective of our study was to review cases of PAS disorders occurring in the last 8 years (2010-2017) in a tertiary care centre, evaluating the forms of treatment chosen and the maternal and fetal outcomes. Methods: Retrospective cross-sectional study using hospital databases (Obscare®, SClinico®) to identify cases of placenta accreta during the study period. Diagnosis was made based on the histological study of placentas submitted for anatomo-pathological study. Results: During the study period, 38 cases of a PAS disorder were diagnosed in 20,910 births (1.8 / 1000), a number that is possibly underestimated. There were 8 women with a previous caesarean section and 6 had placenta previa (2 of them with previous caesarean section). There was ultrasound suspicion of a PAS disorder in 3 cases; of the 4 most severe cases (3 percretas and 1 increta), there was an ultrasound suspicion in 2. Regarding method of delivery, 21 births were by caesarean section and 16 by vaginal delivery. There was 1 case of spontaneous uterine rupture at 20 weeks' gestation with fetal loss; gestational age of birth varied between 32 and 41 weeks; 5 peri-partum hysterectomies were performed; transfusions of blood derivatives were required in 8 women. As for the newborns, there were 8 cases of prematurity and 7 hospitalisations in the Neonatal Intensive Care Unit; fetal death was observed in 2 cases. Conclusion: This case series demonstrate the high prevalence of PAS disorders and the great morbidity associated with it. Adequate antepartum care is essential in women with riskfactors to make the diagnosis timely, thus enabling a multidisciplinary approach with better maternal and fetal outcomes.