Silver Robert M. (ed.) Placenta Accreta Syndrome

CRC Press, 2017. — 167 p. — ISBN13: 978-1-4987-4596-3.Placenta accreta or morbidly adherent placenta (MAP) is one of the most dangerous conditions encountered in pregnancy. It is associated with considerable maternal morbidity including large volume blood transfusion, need for hysterectomy, intensive care unit (ICU) admission, infection, and prolonged hospitalization. Hemorrhage may be fatal or can lead to disseminated intravascular coagulation (DIC) and multiorgan failure.
In fact, the average blood loss at the time of delivery for women with placenta accreta has been reported to be 3000–5000 mL. Other maternal risks include surgical injuries to pelvic viscera and fistula formation. Fetal risks are also considerable and for the most part are due to complications of preterm birth. Rates of placenta accreta are dramatically increasing, primarily due to the increase in the rate of cesarean delivery. The incidence in the United States has increased from a reported 1 in 30,000 in the 1960s to 1 in 500–700 in the last decade. The overwhelming risk factor for placenta accreta is multiple prior cesarean deliveries. The vast majority of women with accreta have had at least one prior cesarean delivery, and the risk increases with the number of cesarean deliveries. The combination of placenta previa and prior cesarean dramatically increases the risk since the placenta overlies the uterine scar. Indeed, women with two or more prior cesareans and a placenta previa are at extreme risk for placenta accreta. Since the rate of cesarean deliveries continues to escalate, the rate of placenta accreta is expected to increase as well.
Despite increasing frequency of the condition, many aspects of the pathophysiology of placenta accreta as well as the optimal method of diagnosis and management of the condition are uncertain. Each center cares for only a relatively small number of cases per year, making formal study of the condition difficult. Consequently, there are no randomized clinical trials and few prospective studies of any design focusing on this increasingly common, life-threatening condition. For example, many believe that cesarean hysterectomy is the safest way to manage accreta based on limited data that shows improved outcomes compared to expectant management leaving the uterus in place. Others advocate conservative management leaving the placenta in situ and awaiting spontaneous involution. There are dozens of such controversies and uncertainties.
We hope that this book will help clinicians caring for these critically ill women. All aspects of diagnosis and treatment of suspected MAP are addressed and controversies are highlighted. Chapters address a diverse array of topics including epidemiology, pathophysiology, diagnosis with ultrasound and magnetic resource imaging (MRI), and all aspects of management. We are fortunate to have an impressive group of authors with multidisciplinary expertise, including anesthesia, maternal–fetal medicine, gynecologic surgery and oncology, radiology, and hematology. Indeed, they are some of the most experienced MAP clinicians in the world. We are indebted to these terrific authors for sharing their experience and expertise.