The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists (ACOG) has issued an opinion paper on placenta accreta. ACOG Committee Opinion No. 266 appears in the January 2002 issue of Obstetrics and Gynecology.
According to the ACOG opinion paper, placenta accreta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta. The incidence of placenta accreta has increased 10-fold in the past 50 years, to a current frequency of 1 per 2,500 deliveries. It has a 7 percent mortality rate as well as intraoperative and postoperative morbidity associated with massive blood transfusions, infection, ureteral damage, and fistula formation.
Risk factors for placenta accreta include placenta previa with or without previous uterine surgery, previous myomectomy, previous cesarean delivery, Asherman's syndrome, submucous leiomyomata, and maternal age of 36 years and older. When any of these conditions are present, the physician should maintain high clinical suspicion for placenta accreta and take the appropriate precautions.
The ACOG committee recommends the use of ultrasonography for diagnosis during the antepartum period. Evidence also indicates that magnetic resonance imaging and color Doppler studies can be useful in defining an abnormally implanted placenta. However, the committee points out that, at this time, no diagnostic technique is 100 percent accurate in diagnosing placenta accreta.
COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group
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