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Placenta accreta is a rare and pontentially life threatening complication of pregnancy, which is characterized by abnormal adherence of the placenta to the uterine wall. Patients with placenta accreta are in high risk of potentially life threatening post partum hemorrhage.

IntroductionThe association of placenta previa and prior cesarean delivery with placenta accreta as a cause of emergency peripartum hysterectomy have been well documented.Emergency peripartum hysterectomy remains a potentially life-saving procedure with which every practitioner of obstetrics must be familiar. Informed consent obtained from the patient scheduled for the elective cesarean section would have to include information about the increased risk of placenta previa, placenta accreta as life threathing complication in the subsequent pregnancies.Eshkoli T, Weintraub AY, Sergienko R,Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013;208(3):219.e1-7.Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KF, Laky C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2011;204(5):411.e1-11.Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN, Simpson LL, Gaddipati S, Sun X, D'Alton ME, Devine P. Predictors of massive blood loss in women with placenta accrete. Am J Obstet Gynecol 2011;205(1):38.e1-6.Stirnemann JJ, Mousty E, Chalouhi G, Salomon LJ, Bernard JP, Ville Y. Screening for placenta accreta at 11-14 weeks of gestation. Am J Obstet Gynecol 2011;205(6):547.e1-6.Clark AS, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011;205(6):S2-S10.Belfort MA, Society for Maternal-Fetal Medicine, Publications Committee. Placenta accrete. Am J Obstet Gynecol 2010;203(5):430-439Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010;202(1):38.e1-9.8. Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, Moore TR, Ramos GA. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol 207(3);216.e1-5.

Prof. dr Ljiljana MirkoviClinic for Gynecology and Obstetrics, Clinical Center of Serbia, Serbiadrljiljamirkovic@gmail.com+381 63 633 780Retrospective analaysis was conducted on deliveried women between the years 2007 2012 at the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia. All the cases of placenta accreta, incretta, percretta was confirmed by hystopathology conclusion. Data regarding demographic characteristics, number and mode of previus deliveries, obstetrical risk factors and the performming of emergency peripartum hysterectomy were collected from hospital charts.The SPSS softwere package was used for statistical analysis. Univariate and multivariate analysis were performed by stepwise logistic regression.

Clinic of Gynecology and Obstetrics, Clinical Centre of SerbiaAuthor : Ljiljana Mirkovi Coauthors : Uro Ravili, Tijana Janji, Radmila Spari, eljka Rali Placenta accrete. Incidence and risk factorsMaterials and MethodsObjectivesResultsConclusionsContact

The objective of the study was to examine the incidence and risk factors for the occurrence of placenta accreta, incretta, percretta in the setting of the large tertiary center with average of 7000 deliveries annually.

ReferencesDuring the study period, there were 47 541 deliveries of which 33 487 were transvaginal and 14 054 (29,56%) by cesarean section. Calculated incidence of placenta accreta, incretta, percretta was 0,19 per 1000 deliveries.

Placenta accreta as complication was found in 9 cases (0,06%) of total number of the caesarean sections.All patients with placenta accreta were delivered by cesarean section.

Emergency peripartum hysterectomy was performed in all of the patients due to significant hemorrhage. During the studied period there were 52 peripartum hysterectomies, and placenta accreta were indication for the peripartum hysterectomy in 17,3% cases.

The following parameters were found to independently influence the risk of the occurrence of placenta accreta in our study: previous cesarean section (OR 8,34; 95% CI 1.73 40.17, p < 0,001), age of the patient > 35 years (OR 4,34; 95% CI 0,01 34,41, p < 0,001, and placenta previa (OR 22,91; 95% CI 1,33 393,79; p < 0,001).

24,8%24,2%27,6%30%32,2%34,1%34,2%YearCesarean Section (%)

Previous SCOdds ratioPatient Age >35Placenta PreviaOdds ratioOdds ratio

Previous SCPatient Age >35Previous SCPlacenta PreviaQUICK TIPS(--THIS SECTION DOES NOT PRINT--)

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