Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Placental adhesive disorders: 6 years’ experience at the Royal Women’s Hospital, Melbourne (#20)

Elske Posma 1
  1. The Royal Womens Hospital, Melbourne, VIC, Australia

Placental adhesive disorders (placenta accreta, increta and percreta) are one of the most difficult conditions an obstetrician can encounter. The incidence has substantially increased over the last 2 decades, with the increased caesarean section rate as the main contributor. At the Royal Women’s Hospital in Melbourne the rate of placental adhesive disorders per 1000 deliveries increased from 0.75 in 2004 to 1.89 in 2010.
Placental adhesive disorders are associated with significant maternal and fetal morbidity and mortality. To optimize management strategies for this condition, timely diagnosis and a multidisciplinary approach are paramount.
In 2010, the Royal Women’s Hospital developed a comprehensive guideline for the management of placental adhesive disorders, tailored to the co-location of our tertiary maternity hospital with the Royal Melbourne Hospital. All relevant specialties were involved, including obstetrics, (gynae)-oncology, anaesthetics, urology, interventional radiology, imaging, haematology, complex- and intensive care, neonatology, midwifery staff and ancillary staff.
The guideline covers imaging protocols, guidance for counseling and antenatal, intra-operative and postnatal management requirements. It also includes a pre-operative checklist, which is helpful to ensure all relevant investigations and preparations are in place.
The preferred management option is caesarean hysterectomy. When a placenta percreta is suspected, after delivery of the baby via a classical caesarean, the patient is transferred to the Royal Melbourne Hospital interventional radiology suite for embolization of the placental bed prior to the hysterectomy to try and minimize intra-operative blood loss. Conservative treatment is offered as an option should there be a desire to preserve fertility.
Outcome data have been collected since 2009, with patients divided into 3 groups (caesarean hysterectomy, conservative management and undiagnosed group) on an intention-to-treat basis.
This presentation will be an overview on placental adhesive disorders. The Royal Women’s Hospital guideline will be discussed, and the preliminary outcome data from our population since 2009 will be presented.