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    Diagnosis and management of accreta



    Dr Esakoff is Assistant Clinical Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center, Los Angeles, California.


    Morbidly adherent placenta (MAP) includes the continuum of placenta accreta, increta, and percreta. The incidence of placenta accreta has steadily increased in recent decades, from 1 in 2510 pregnancies in the early 1980s to 1 in 533 pregnancies in the period 1982–2002.1-3 Placenta accreta carries a mortality rate of up to 10% and accounts for the majority of cesarean hysterectomies performed.4 Risk factors include prior uterine surgery, placenta previa, advanced maternal age, and parity of 3 or more.

    Interestingly, a recent large maternal-fetal medicine units (MFMU) study found that prior myomectomy does not appear to be associated with higher risk of placenta accreta. The climbing cesarean delivery rate, however, is thought to be directly linked to the increasing incidence of accreta.5 In the 1970s, the overall cesarean rate was 5.5% but by 2012, it had increased to 32.8% of all deliveries.6 The striking link between history of cesarean and placenta accreta was illustrated in a study comparing the number of prior cesareans and the risk of placenta accreta in the current pregnancy7 (Table 1). Even in the absence of a placenta previa in the current pregnancy, the risk of accreta was almost 5% in the setting of 5 prior cesareans. If the patient had a previa in the current pregnancy, the risk rose to 40% with just 2 prior cesareans7 (Table 1).

    Tania F. Esakoff, MD
    Dr. Esakoff is an Assistant Professor of Obstetrics and Gynecology in the Department of Obstetrics and Gynecology, Division of Maternal ...


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