7 doctors weighed in:

What is the best way of managing placenta accreta and percreta?

7 doctors weighed in
Dr. Wayne Ingram
Obstetrics & Gynecology
4 doctors agree

In brief: Resorption

If placenta percreta/accreta is recognized at the time of delivery and there is no bleeding then allowing the uterus to contract and retained placenta to be excreted or absorbed later on its' own volition is a wise course.
However, if there is massive uncontrollable bleeding then cesarean hysterectomy is the "default" choice. Uterine balloon "packing" can be also be tried to arrest bleeding.

In brief: Resorption

If placenta percreta/accreta is recognized at the time of delivery and there is no bleeding then allowing the uterus to contract and retained placenta to be excreted or absorbed later on its' own volition is a wise course.
However, if there is massive uncontrollable bleeding then cesarean hysterectomy is the "default" choice. Uterine balloon "packing" can be also be tried to arrest bleeding.
Dr. Wayne Ingram
Dr. Wayne Ingram
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Dr. Nikolaos Zacharias
Obstetrics & Gynecology - Maternal Fetal Medicine
1 doctor agrees

In brief: C-hysterectomy @34w.

A planned prelabor cesarean hysterectomy by 34-35 weeks after administration of Betamethasone is the optimal management of placenta accreta.
Increta/percreta. This should be done only at tertiary care centers with ICU and blood bank availability and in consultation with oncologist, urologist and even general or vascular surgeon. Do not attempt placental delivery when accretism is suspected!

In brief: C-hysterectomy @34w.

A planned prelabor cesarean hysterectomy by 34-35 weeks after administration of Betamethasone is the optimal management of placenta accreta.
Increta/percreta. This should be done only at tertiary care centers with ICU and blood bank availability and in consultation with oncologist, urologist and even general or vascular surgeon. Do not attempt placental delivery when accretism is suspected!
Dr. Nikolaos Zacharias
Dr. Nikolaos Zacharias
Thank
Dr. Nikolaos Zacharias
Obstetrics & Gynecology - Maternal Fetal Medicine

In brief: Planned c-hyst @34 w

Prelabor cesarean hysterectomy at 34-35 weeks after empiric Betamethasone administration in a large tertiary care center with collaboration between mfm, gynecology-oncology, urology, blood bank, neonatology and sicu/general surgery is the optimal approach.
Do not attempt to deliver the placenta! leaving the placenta is nitu can be life-saving if immediate surgical therapy is not possible.

In brief: Planned c-hyst @34 w

Prelabor cesarean hysterectomy at 34-35 weeks after empiric Betamethasone administration in a large tertiary care center with collaboration between mfm, gynecology-oncology, urology, blood bank, neonatology and sicu/general surgery is the optimal approach.
Do not attempt to deliver the placenta! leaving the placenta is nitu can be life-saving if immediate surgical therapy is not possible.
Dr. Nikolaos Zacharias
Dr. Nikolaos Zacharias
Thank
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