Women’s health: Edited by Joseph AquilinaThe morbidly adherent placenta diagnosis and management optionsHayes, Ellen; Ayida, Gubby; Crocker, Alison Author Information Chelsea & Westminster Hospital, London, UK Correspondence to Gubby Ayida, MA, FRCOG, DM (Oxon), Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Tel: +44 208 846 7900; e-mail: [email protected] Current Opinion in Obstetrics and Gynecology: December 2011 - Volume 23 - Issue 6 - p 448-453 doi: 10.1097/GCO.0b013e32834cef7a Buy Metrics Abstract Purpose of review Randomized controlled trials and large cohort studies regarding the diagnosis and management of placenta accreta are lacking. This review examines the available evidence. Recent findings Avoiding the placenta and leaving it attached at time of elective caesarean section to proceed with either delayed hysterectomy or conservative management is currently recommended. Recent literature has focussed on conservative management. Routine use of methotrexate in conservative management is no longer advocated. Use of emergency balloon catheter placement and embolization in tertiary centres where access to interventional radiology is immediately available may be favourable to prophylactic balloon catheter placement. Follow-up of patients undergoing conservative management should include ultrasonographic follow-up, human chorionic gonadotropin levels have been shown not to correlate with rate of placental resorption. Summary Women with an antenatal diagnosis of placenta accreta should be managed in a tertiary facility with multidisciplinary input. To determine optimum management strategies, it is imperative that larger studies are carried out in the future. It is essential that the continual monitoring and containment of rising caesarean section rates becomes a priority to prevent a further increase in the incidence of placenta accreta. © 2011 Lippincott Williams & Wilkins, Inc.
