The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study

Abstract

ObjectiveTo describe the management and outcomes of placenta accreta, increta, and percreta in the UK. DesignA population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). SettingAll 221 UK hospitals with obstetrician-led maternity units. PopulationAll women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. MethodsProspective case identification through the monthly mailing of UKOSS. Main outcome measuresMedian estimated blood loss, transfusion requirements. ResultsA cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100ml, P=0.008) and a reduced need for blood transfusion (59 versus 94%, P=0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P=0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P<0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700ml, P=0.001) and a reduced need for blood transfusion (57 versus 86%, P<0.001). ConclusionsWomen with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.