• Best Pract Res Clin Obstet Gynaecol · Dec 2008

    Diagnosis and management of placenta accreta.

    • José Miguel Palacios-Jaraquemada.
    • CEMIC University Hospital, Department of Gynaecology and Obstetrics; J. J. Naón Morphological Institute, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. jpalacios@fmed.uba.ar
    • Best Pract Res Clin Obstet Gynaecol. 2008 Dec 1; 22 (6): 1133-48.

    AbstractThe diagnosis of placenta accreta begins with clinical suspicion in patients at risk. Ultrasound and Doppler are first-choice diagnostic methods because of their accessibility and high sensitivity. Placental MRI is an accurate method of topographic stratification that makes it possible to define anatomy, to plan the surgical approach and to consider other therapeutic possibilities. Management of placenta percreta involves great technical dexterity and significant clinical support. The main challenges include controlling the haemorrhage and dissection of the invaded tissues. Nowadays, there are two treatment options: caesarean hysterectomy or a conservative approach. With the latter, there is a choice between leaving the placenta in situ and waiting for its later resolution, and a one-step surgery that addresses the problems of invasion, vascular control and myometrial damage in a single surgical act.

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