Management of placenta praevia and accreta

Abstract

With the rising incidence of caesarean sections, the numbers of cases of placenta praevia accreta and its complications is continuing to increase. There is a paucity of information about the management of placenta praevia accreta. An Embase and MEDLINE search was performed using the keywords 'placenta praevia', 'placenta accreta', and 'placenta praevia and accreta', from 1978 to 2010. Further articles were identified by cross-referencing. In addition to the above information from the Royal College of Obstetricians and Gynaecologists Guideline on placenta praevia and placenta praevia accreta, RCOG Guideline No. 27 and the Confidential Enquiry into Maternal Deaths in the UK were searched. The review discusses the incidence, predisposing factors, pathogenesis, diagnosis, clinical implications and management options of this condition. It is concluded that a multidisciplinary team approach is essential to reduce neonatal and maternal morbidity and mortality. The mainstay of treatment is by caesarean hysterectomy, however in carefully selected cases, conservative options may be considered with caution.