Placenta Accreta: A Retrospective Study of Risk Factors, Maternal and Fetal Outcomes in a Tertiary Hospital in Puerto Rico

Placenta accreta occurs when the deciduas basal is that separates the placental villi from the myometrium is missing. Classification is divided in 3 grades based on histopathologic analysis consisting on: placenta accreta, increate and percent. Placenta accreta occurs when the chorionic villi of the placenta enters in contact with the myometrium. In placenta increta, the chorionic villi invade the myometrium and in placenta percreta the chorionic villi penetrate the uterine serosa. The reported incidence of placenta accreta has increased 10 fold, occurring in about 1:533 pregnanciesfor the period of 1982-2002. Among patients with a histological diagnosis of abnormal placental invasion, 81.6% of cases were placenta accreta, 11.8% were placenta increta, and 6.6% were placenta percreta [1]. This increase in incidence has been attributed to the prevalence of previously described risk factors, being previous cesarean section one of the most important [2]. Placenta Accreta has been implicated to increase morbidity/ mortality in the maternal population with detrimental outcomes to the patient as well as to the fetus. It has become one of the leading causes for emergency hysterectomy worldwide accounting for a 51.1% of emergency hysterectomies. In addition, it is associated with a maternal morbidity in 60% of cases and a mortality of up to 7% of cases [3-5]. Life threatening bleeding is the most common complication. The average blood loss reported at the time of delivery is between 3000-5500mL, which leads to significant postoperative morbidity and mortality [6]. Its early recognition and diagnosis are one of the main goals of management.