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Prenatal sonographic diagnosis of placenta accreta—Impact on maternal and neonatal outcomes
Author(s) -
Hall Tania,
Wax Joseph R.,
Lucas F. Lee,
Cartin Angelina,
Jones Michael,
Pinette Michael G.
Publication year - 2014
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.22186
Subject(s) - medicine , placenta accreta , placenta percreta , obstetrics , coagulopathy , retrospective cohort study , neonatal intensive care unit , prenatal diagnosis , intensive care unit , blood transfusion , pregnancy , apgar score , fetus , pediatrics , surgery , placenta , genetics , biology
Purpose To compare maternal and neonatal outcomes of prenatally diagnosed versus undiagnosed cases of placenta accreta. Methods This retrospective study included all pathology‐proven placentas accreta/increta/percreta from a single tertiary center from January 1, 2005 to December 31, 2012. Outcomes were compared between prenatally diagnosed and undiagnosed cases. Results Thirty‐six cases of abnormal implantations were identified, of which 19 (53%) were prenatally diagnosed by ultrasound. Prenatal detection was more likely with a percreta (7/19 versus 2/17, p = .07), parity (18/19 versus 9/17, p = .01), prior cesarean (17/19 versus 4/17, p = .0001), shorter cesarean‐conception interval (22.8 ± 21.4 versus 108 ± 7.6 months, p = .01), and spontaneous conception (19/19 versus 12/17, p = .03). Cases diagnosed prenatally more frequently received steroids for fetal maturity (13/20 versus 3/19, p = .003), delivered by cesarean (19/19 versus 11/17, p = .01) under general anesthesia (14/19 versus 4/17, p = .002) with a cell saver (5/19 versus 0/17, p = .06). There were no statistically significant differences by group in maternal blood loss, transfusion, intensive care admission or length of stay, operative injury, or severe composite morbidity (reoperation, coagulopathy, thromboembolism, wound infection, multiorgan failure, transfusion reaction, fistula, or chest compressions). There were no statistically significant differences in 5‐minute Apgar <7, neonatal intensive care unit admission or length of stay, or severe composite morbidity. Conclusion Prenatally undiagnosed accretas are less complex than prenatally diagnosed cases, but associated with statistically similar outcomes, suggesting benefit to prenatal recognition. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :449–455, 2014