Surgical Management of Placenta Accreta

This chapter discusses the surgical management of morbidly adherent placenta in a variety of scenarios. The management of placenta accreta involves careful preoperative planning and preparation to minimize the morbidity and mortality. Prior to the planned surgical procedure, a number of secondary measures can be undertaken that may reduce perioperative morbidity. The most crucial component of the antepartum management of placenta accreta is the establishment of a multidisciplinary team that will discuss the case prior to delivery. A number of topical hemostatic agents are currently available in the United States to promote hemostasis. The surgical management of unexpected placenta accreta represents a major challenge. Placenta accreta is an extremely serious condition that often leads to severe complications at the time of termination of pregnancy. Placenta accreta is one of the most common reasons for cesarean hysterectomy. In a population-based descriptive study using the UK Obstetric Surveillance System, Knight reported that 38% of peripartum hysterectomies were due to morbidly adherent placenta.