Conservative management of placenta praevia with accreta

Ben CP Chan, Helena SW Lam, Jimmy HF Yuen, Tina PW Lam, WK Tso, TC Pun, CP Lee
Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong

It has been advocated that placenta accreta/percreta should be managed conservatively to avoid massive pelvic bleeding and preserve fertility. Diagnosis of this condition with high-resolution imaging investigations performed during the antenatal period facilitates discussion of management plans with other clinical disciplines (eg interventional radiologists), the patient, and her family. Three cases of placenta praevia with accreta are presented. The three cases were managed by leaving the placenta in-utero after caesarean section, using uterine arterial embolisation to control postpartum haemorrhage only when needed. In all these cases, we succeeded in conserving the uterus without major complications. With improved imaging techniques, accurate antenatal diagnosis of placenta praevia with accreta is now possible. This new approach to conservative management can be considered in order to not only conserve the uterus but also to avoid uncontrolled pelvic haemorrhaging.

Hong Kong Med J 2008;14:479-84

Key words: Cesarean section; Embolization, therapeutic; Placenta accreta; Placenta previa; Prenatal diagnosis