• Man Y Chung, Yvonne K Y Cheng, Simon C H Yu, Daljit S Sahota, and Tak Y Leung.
• Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
• Acta Obstet Gynecol Scand. 2013 Nov 1;92(11):1250-5.

ObjectiveTo evaluate the outcome of three different modes of management of abnormally invasive placenta over a 6-year period.DesignRetrospective cohort study.SettingTertiary hospital in Hong Kong.PopulationIn 39 757 deliveries, 25 cases of abnormally invasive placenta were identified at cesarean section.MethodsIdentification of cases by hospital database and review of medical records.Main Outcome MeasuresBlood loss, blood transfusion requirement, operative time, duration of hospital stay, secondary postpartum hemorrhage and endometritis.ResultsSix women were managed by leaving the placenta in situ and by postoperative uterine artery embolization. Ten women were managed by an extirpative approach and nine women with direct cesarean hysterectomy. The success rate of nonremoval of the placenta with uterine artery embolization was 4/6 (67%). The intraoperative blood loss, blood transfusion requirements and operation times were lowest in the group with nonremoval of the placenta, although a higher secondary complication rate and a longer hospital stay followed.ConclusionNonremoval of an abnormally invasive placenta at cesarean section and prophylactic postoperative uterine artery embolization are an alternative to elective cesarean hysterectomy.© 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

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