Management of placenta accreta

Placenta accreta, also known as abnormally invasive placenta, is defined as an abnormally deep invasion of the placenta at the site of implantation. The term ‘increta’ is used for deep invasion in the myometrium, whereas ‘percreta’ refers to involvement of the serosa or even adjacent organs, the most common of which is the bladder. Nevertheless, the term ‘accreta’ is frequently used to group together these three definitions. Attempting to force delivery leads to serious haemorrhage, which usually requires hysterectomy under difficult conditions, with a risk to the mother's vital prognosis and complications in the surrounding organs (bladder and ureteral wounds, vascular lesions). Identification of placenta accreta prior to delivery is essential in order to define the modalities for multidisciplinary management and reduce maternal complications. Two main types of therapeutic approach are discussed, either caesarean section-hysterectomy or conservative treatment with the placenta left in situ.