[Placenta accreta: diagnosis and management in a French type-3 maternity hospital]. / Placenta accreta: diagnostic et prise en charge Etat des lieux dans une maternité de type 3.

ABSTRACT

OBJECTIVE: Placenta accreta is a rare obstetrical pathology but leads to a high morbidity. It is likely to become increasingly frequent as the rate of cesarean section increases in developed countries. The aim of our study was to describe the diagnostic and management of patients with placenta accreta, during the last ten years, in a French high-level maternity. MATERIAL AND METHOD: This is a retrospective study of the prenatal diagnosis and management of placenta accreta with histological confirmation in our department between 1996 and 2006. RESULTS: The rate of placenta accreta in our study was 0.52 per thousand. Ninety-six percent of the patients had risk factors for placenta accreta. Placenta accreta was diagnosed in 24% of the patients by sonographic examination. Magnetic resonance imaging did not increase sensitivity. Eighty-eight percent of the patients required a hysterectomy. No digestive or urinary complications occurred. There were no maternal deaths. CONCLUSION: Despite established ultrasound and MRI-based diagnostic criteria for placenta accreta, this condition remains difficult to diagnose in the general population. Morbidity associated with this pathology is serious, especially in cases of hemostatic hysterectomy. When placenta accreta is diagnosed prior to delivery, care in a high-level maternity hospital must be considered to improve management.