The Management of Placenta Accreta at Queen’s Hospital, Romford, UK

Placenta accreta, increta and percreta are all forms of morbidly adherent placenta (MAP) with abnormally invasive placentation. Histologically defined by trophoblastic invasion of the myometrium in the absence of intervening decidua, superficial myometrial invasion is classed as accreta, deeper myometrial invasion as increta, and invasion through the serosa or into adjacent pelvic organs as percreta1. The condition was of such rarity 60 years ago that many experienced practicing obstetricians had never encountered a case, and the associated maternal mortality rate was extremely high (37–67% of cases managed)2. Although associated maternal mortality is now significantly lower (7–10% of cases)3,4, it remains a much dreaded obstetric complication primarily because of the risk to the mother. Although awareness of the condition and its attendant risks is increasing, no consensus exists regarding the best management strategies to maximize outcomes. This paucity of information hampers service planning and decisions on optimal management strategies and presents difficulties in conducting meaningful research, particularly comparative studies (see Chapter 1).