The Aftermath of Conservative Management of Placenta Accreta: Can These Women and Their Uteri Handle Another Pregnancy?



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BACKGROUND: Placenta accreta, an invasion of the placenta into the myometrium of the uterus, is one of the leading causes of postpartum hysterectomies. The American Congress of Obstetrics and Gynecology (ACOG) recommends that when placenta accreta is suspected, a hysterectomy should be performed without attempting to remove the placenta. Several methods exist for the conservative management of placenta accreta, which leaves women capable of subsequent pregnancies. OBJECTIVE: The purpose of this literature review is to evaluate the fertility and pregnancy outcomes of women who undergo conservative management of placenta accreta. METHODS: An online literature search was performed looking for key works. Retrieved articles, their references, and past literature reviews on the subject were screened for relevance. RESULTS: Several studies assessing the fertility outcomes of women after conservative management of placenta accreta were found. 345 subsequent live births were documented with a recurrence rate of placenta accreta of 21%. It was found that previous C-sections and placenta previa pose the greatest statistical risk for placenta accreta. Relatively few women desired another pregnancy and postpartum hemorrhage can have a significant negative psychological impact on women. CONCLUSION: Women who undergo conservative management of placenta accreta can successfully carry pregnancies to term. Children born of these pregnancies have no neonatal morbidity. The rate of recurrence of placenta accreta and postpartum hemorrhage remains high.

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