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• W1973790469 abstract "ObjectiveTo compare acute and long-term outcomes associated with surgical versus conservative management of placenta accreta-percreta.Study designA systematic review of reported cases on placenta accreta-percreta conducted by MEDLINE search from 1966 to 2003, using key words “placenta accreta-percreta.” 115 publications were reviewed and combined with 19 cases from Ottawa Hospital over the last 10 years. Cases were classified according to whether hysterectomy was done at time of delivery (surgical management) or whether an attempt was made to preserve the uterus with or without delivery of the placenta (conservative management). Complications and interventions were recorded as acute (<24 hrs post delivery) and long-term (>24 hrs to 1 year). The impact of antenatal diagnosis was also analyzed.ResultsA total of 166 cases were reviewed: 115 cases managed surgically and 51 cases, conservatively. Acute complication rates were significantly higher in the surgical group versus the conservative group: severe hemorrhage >3 liters (65% vs 14%), DIC (17% vs 2%), and cystostomy-cystectomy (43% vs 4%). In the long-term period, the conservative group had higher rates of readmission (29% vs 4%), delayed severe hemorrhage >3 liters (25% vs 7%), infections (37% vs 14%), and surgical re-interventions (73% vs 20%) including delayed hysterectomy (20%). Antenatal diagnosis was reported in 30% of cases managed surgically and in 35% of the conservative group, influencing the mode of delivery while reducing the incidence of severe intrapartum hemorrhage by 33% and bladder damage by 15%.ConclusionConservative management of placenta accreta-percreta results in uterine preservation in 80% of cases while significantly reducing severe intrapartum blood loss and bladder injury. It comes at a cost of prolonged follow-up, delayed hemorrhagic complications, and increased rates of hospital readmission with surgical re-intervention. ObjectiveTo compare acute and long-term outcomes associated with surgical versus conservative management of placenta accreta-percreta. To compare acute and long-term outcomes associated with surgical versus conservative management of placenta accreta-percreta. Study designA systematic review of reported cases on placenta accreta-percreta conducted by MEDLINE search from 1966 to 2003, using key words “placenta accreta-percreta.” 115 publications were reviewed and combined with 19 cases from Ottawa Hospital over the last 10 years. Cases were classified according to whether hysterectomy was done at time of delivery (surgical management) or whether an attempt was made to preserve the uterus with or without delivery of the placenta (conservative management). Complications and interventions were recorded as acute (<24 hrs post delivery) and long-term (>24 hrs to 1 year). The impact of antenatal diagnosis was also analyzed. A systematic review of reported cases on placenta accreta-percreta conducted by MEDLINE search from 1966 to 2003, using key words “placenta accreta-percreta.” 115 publications were reviewed and combined with 19 cases from Ottawa Hospital over the last 10 years. Cases were classified according to whether hysterectomy was done at time of delivery (surgical management) or whether an attempt was made to preserve the uterus with or without delivery of the placenta (conservative management). Complications and interventions were recorded as acute (<24 hrs post delivery) and long-term (>24 hrs to 1 year). The impact of antenatal diagnosis was also analyzed. ResultsA total of 166 cases were reviewed: 115 cases managed surgically and 51 cases, conservatively. Acute complication rates were significantly higher in the surgical group versus the conservative group: severe hemorrhage >3 liters (65% vs 14%), DIC (17% vs 2%), and cystostomy-cystectomy (43% vs 4%). In the long-term period, the conservative group had higher rates of readmission (29% vs 4%), delayed severe hemorrhage >3 liters (25% vs 7%), infections (37% vs 14%), and surgical re-interventions (73% vs 20%) including delayed hysterectomy (20%). Antenatal diagnosis was reported in 30% of cases managed surgically and in 35% of the conservative group, influencing the mode of delivery while reducing the incidence of severe intrapartum hemorrhage by 33% and bladder damage by 15%. A total of 166 cases were reviewed: 115 cases managed surgically and 51 cases, conservatively. Acute complication rates were significantly higher in the surgical group versus the conservative group: severe hemorrhage >3 liters (65% vs 14%), DIC (17% vs 2%), and cystostomy-cystectomy (43% vs 4%). In the long-term period, the conservative group had higher rates of readmission (29% vs 4%), delayed severe hemorrhage >3 liters (25% vs 7%), infections (37% vs 14%), and surgical re-interventions (73% vs 20%) including delayed hysterectomy (20%). Antenatal diagnosis was reported in 30% of cases managed surgically and in 35% of the conservative group, influencing the mode of delivery while reducing the incidence of severe intrapartum hemorrhage by 33% and bladder damage by 15%. ConclusionConservative management of placenta accreta-percreta results in uterine preservation in 80% of cases while significantly reducing severe intrapartum blood loss and bladder injury. It comes at a cost of prolonged follow-up, delayed hemorrhagic complications, and increased rates of hospital readmission with surgical re-intervention. Conservative management of placenta accreta-percreta results in uterine preservation in 80% of cases while significantly reducing severe intrapartum blood loss and bladder injury. It comes at a cost of prolonged follow-up, delayed hemorrhagic complications, and increased rates of hospital readmission with surgical re-intervention." @default.
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• W1973790469 title "Outcomes of surgical versus conservative management of placenta accreta-percreta: systematic review of literature and case series" @default.
• W1973790469 doi "https://doi.org/10.1016/j.ajog.2003.10.246" @default.
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