Controversies in the Management of Placenta Accreta

Luis Pacheco, Alfredo F. Gei

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality worldwide, and abnormal placentation, including placenta accreta, is currently the most common indication for peripartum hysterectomy. Prenatal identification of these cases and early referral to centers with the capability to manage them will likely result in improved outcomes. Interventions that may limit transfusion requirements include normovolemic hemodilution, selective embolization of pelvic vessels by interventional radiology, conservative management of accretism in a few selected cases, and the use of the cell saver intraoperatively. Current understanding of the mechanisms of acute coagulopathy has questioned the current transfusion guidelines, leading to a tendency to apply massive transfusion protocols based on hemostatic resuscitation. Prospective trials are required to validate the efficacy of this approach. Obstetricians should be familiar with current transfusion protocols, as the incidence of placental accretism is expected to increase in the future.

Original languageEnglish (US)
Pages (from-to)313-322
Number of pages10
JournalObstetrics and Gynecology Clinics of North America
Volume38
Issue number2
DOIs
StatePublished - Jun 2011

Fingerprint

Placenta Accreta
Peripartum Period
Interventional Radiology
Placentation
Hemodilution
Maternal Mortality
Hemostatics
Hysterectomy
Resuscitation
Obstetrics
Referral and Consultation
Guidelines
Hemorrhage
Morbidity
Incidence
Conservative Treatment

Keywords

  • Hemorrhage
  • Placenta accreta
  • Pregnancy
  • Transfusion

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Controversies in the Management of Placenta Accreta. / Pacheco, Luis; Gei, Alfredo F.

In: Obstetrics and Gynecology Clinics of North America, Vol. 38, No. 2, 06.2011, p. 313-322.

Research output: Contribution to journalArticle

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