The impact of antenatal diagnosis of placenta accreta on reducing blood loss: a 57-case monocenter retrospective study

ABSTRACT

Objective. The aim of our study was to investigate the impact of antenatal diagnosis of PA on blood loss, blood transfusions, and maternal and neonatal morbidity and mortality.
Materials and Methods. This is a monocenter retrospective study including all patients who had failed manual removal of the placenta or evidence of placental invasion at the surgery. The patients included were divided into 2 groups:
– Group 1: patients with an antenatal diagnosis according to the ultrasounds or magnetic resonance imaging data.
– Group 2: patients with unexpected placenta accreta.
Then, we compared blood loss estimated by Gross formula, transfusions, and maternal and neonatal morbidity in both groups.
Results. In our series, 57 cases of PA were included: 35 patients with antenatal diagnosis (group 1) and 22 with unexpected PA (group 2). The bleeding estimation was 1610 ± 908 ml in group 1 versus 2480 ± 1317 ml in group 2, with p = 0.007. The need for transfusion was reduced from 95.4 % to 17 % when PA was diagnosed antenatally with p = 0.001. Unexpected PA was correlated with an increased risk of severe bleeding with OR 2.35; 95%CI 1.08-5.62 and transfusion requirements with OR 1.85; 95%CI: 1.18- 6.1. However, expected PA was correlated with a higher risk of prematurity with OR 2.04, 95%CI 1.05-4.8.
Conclusions. The antenatal diagnosis of placenta accreta allowed better maternal outcomes by reducing the blood loss and transfusions requirements. However, it increased the incidence of planned preterm birth.