Berthelot-Ricou A, Villot A, Bernard J, Eggermont-Gavage J, Birsan-Frances A and Von Theobald P
Background: Placenta percreta, accreta, increta and transcreta are abnormal placentation adherence (APA), significantly associated with high maternal morbidity and mortality. When APA is suspected antenatally there are two current recommended alternatives: a radical treatment by planned cesarean-hysterectomy or a conservative management leaving the placenta in place with secondary uterine devascularization by embolisation, in aim to preserve fertility but at the cost of heavy monitoring and possibly severe complications and secondary hysterectomy. A third option could be considered when APA is antenatally diagnosed. This is a multidisciplinary planned management, consisting in per operative placental localization and delivery of the fetus via transverse uterine incision above the upper edge of the placenta. Then pelvic devascularization by inflation of internal iliac artery balloons preoperatively inserted is established and excision of the accreta part of the placenta followed by reconstruction of the uterine wall defect with healthy myometrium is performed. Principe of the work: We evaluated the management and outcome of all APA diagnosed between January 1st 2012 and 31 July 2013, in a Reunion Island tertiary care center, and describe our first case of placenta percreta managed according to this new multidisciplinary conservative alternative technique. Statement of main conclusion: 7 cases of APA occurred during the study period, and have been systematically complicated of severe Post-Partum Hemorrhage (PPH) and hysterectomy in four cases. Train finding: This first case report of multidisciplinary planned CS and conservative management of a placenta percreta was also the first one uncomplicated to PPH, transfusion or hysterectomy, in our service since 2 years. This new alternative seems very encouraging, must be available as soon as possible and should be evaluated prospectively.