Contemporary management of abnormal invasive placenta - placenta accreta/increta/percreta (article in Czech)
Michal Koucký, Hana Vráblíková, Andrej Černý, Pavel Calda
Actual Gyn 2016, 8, 42-47
Publication date: 2016-09-05
Manuscript ID: 0715023
Number of views: 2071

Abnormal placental invasion (AIP) is one of the obstetrics most actual topics today. Increased incidence is caused through increased number of surgeries performed on uterus, caesarean sections but also myomectomies. Prenatal ultrasound diagnostics can predict the risk of AIP with increasing sensitivity and specificity, AIP management requires an individual multidiscipline approach. Main goal of the management is to eliminate the risk of life threatening bleeding. When during the cesarean section the invasion of trophoblast to uterine wall is obvious (especially if widespread) we rather choose to perform hysterectomy without removing the placenta from the uterus. If a skilled operator, usually with onco-gynecologic background is available; we can proceed with surgical removal of the uterus. If the surgical approach would be connected with higher risk for the patient, and the skilled operator would not always be available, it is possible to limit the threatening bleeding by means of interventional radiology. In this case, a skilled and available radiologist, together with necessary equipment (hybrid operation theatre) must be available. Conservative approach with placenta removal and treatment of sources of bleeding can be chosen only in cases of focal placenta accreta or when the patient pretends on fertility preservation.

Key words: abnormally invasive placenta, placenta accreta, placenta increta, placenta percreta, caesarean section, hysterectomy