Surgical Management of Placenta Accreta — Does Staged Procedure Help?

Objectives: To determine whether staged procedure involving classical Caesarean section without removing the placenta followed by arterial embolisation before hysterectomy had any clinical value in the surgical management of placenta accreta. Methods: This retrospective case-controlled study was conducted in a tertiary obstetric unit in Hong Kong. All hysterectomy cases with confirmed histological diagnosis of placenta accreta from 1 January 2000 to 31 December 2011 were reviewed. The main outcome measures were total anaesthetic time, anaesthetic time before delivery, intra-operative blood loss, postoperative haemoglobin level, the need and amount of blood product transfusion, and the need and length of stay in the intensive care unit. Results: A total of 35 cases of placenta accreta / percreta / increta were confirmed by histological diagnosis; 12 cases had successful staged procedure. These cases had significantly less operative blood loss (median, 1350 vs. 4500 mL; p=0.007), higher postoperative haemoglobin level (mean, 94 vs. 76 g/L; p=0.03), less need for blood transfusion (5 vs. 19 cases; p=0.022), and less amount of blood transfused (median, 0 vs. 10 units; p=0.003) than those who did not undergo staged procedure. The mean anaesthetic time before delivery of staged procedure group was longer (49.5 vs. 12.8 mins in the non–staged procedure group; p<0.001). However, there was no significant difference in the two groups in terms of the total anaesthetic time, as well as the need and length of stay in the intensive care unit. Conclusion: In managing patients with placenta accreta, staged procedure involving classical Caesarean section without removing the placenta followed by arterial embolisation before hysterectomy was associated with decreased operative blood loss. Hong Kong J Gynaecol Obstet Midwifery 2014; 14(1):64-74