Marcellin L, et al. - Comparison of maternal morbidity from placenta percreta and accreta was performed. Women with placenta percreta vs with placenta accreta exhibited severe maternal morbidity much more frequently, despite multidisciplinary planning, management in a referral center, and better antenatal suspicion.

Methods

• Researchers performed a retrospective study at a referral center in Paris including all women with abnormally invasive placentation from 2003 to 2017.
• Diagnsis of placenta percreta and accreta was performed histologically or clinically.
• A conservative approach leaving the placenta in situ was proposed when placenta percreta was suspected before birth because of the intraoperative risk of cesarean delivery.
• They offered parents a choice of a conservative approach or an attempt to remove the placenta, to be followed in case of failure by hysterectomy when placenta accreta was suspected.
• Women with placenta percreta and those with placenta accreta/increta were compared regarding maternal outcomes.
• For this work, the primary outcome measure was a composite criterion of severe acute maternal morbidity including at least one of the following: hysterectomy during cesarean delivery, delayed hysterectomy, transfusion of ≥10 units of packed red blood cells, septic shock, acute kidney injury, cardiovascular failure, maternal transfer to intensive care, or death.

Results

• This study included 156 women; 51 had placenta percreta and 105 placenta accreta.
• Abnormally invasive placentation was suspected antenatally nearly four times more frequently in the percreta than the accreta group (96.1% (49/51) vs 25.7% (27/105), P <0.01).
• Among the 76 women with antenatally suspected abnormally invasive placentation (48.7%), the percreta group had higher rate of antenatal decisions for conservative management than the accreta group (100% (49/49) vs 40.7% (11/27), P<0.01).
• The percreta group had significantly higher composite maternal morbidity rate than the accreta group (86.3% (44/51) vs 28/105 (26.7%), P <0.001).
• A secondary analysis restricted to women with an abnormally invasive placentation diameter > 6 cm demonstrated similar results (86.0% (43/50) vs 48.7% (19/38), P <0.01).
• Significantly higher rate of hysterectomy during cesareans was noted in the percreta than the accreta group (52.9% (27/51) vs 20.9% (22/105), P < 0.01) as was noted for the total hysterectomy rate (43/51 (84.3%) vs 23.8% (25/105), P <0.01).