• S E Grace Tan, Thomas W Jobling, Euan M Wallace, L Jane McNeilage, Thomas Manolitsas, and Ryan J Hodges.
• Maternal Fetal Medicine Unit, Monash Medical Centre, Southern Health, Clayton, Victoria, Australia.
• Acta Obstet Gynecol Scand. 2013 Apr 1;92(4):445-50.

ObjectiveTo examine maternal morbidity in primary surgical management of placenta accreta.DesignRetrospective case series.SettingQuaternary perinatal referral center in Melbourne, Australia.PopulationClinically suspected and histologically confirmed cases of placenta accreta, increta and percreta.MethodsWomen were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records.Main Outcome MeasuresPredefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive (NICU) or special care nurseries (SCN), respiratory distress syndrome.ResultsBetween 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy (p = 0.04). Nearly two-thirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products (p = 0.03), sustain renal tract injury (p = 0.003) and require intensive care admission (p = 0.002).ConclusionsA primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center.© 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

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