VP44.06: Placenta accreta spectrum: antenatal diagnosis, prognosis and treatment

The aims of our work were to determine the main risk factors for placenta accreta, to analyse the input of ultrasound in prenatal diagnosis, and to assess the prognosis in case of radical treatment. The study at hand was descriptive and retrospective and has been conducted over a three years and five months' period from January 2017 to June 2020. We have mapped 52 cases of patients having received a first line radical treatment for placenta accreta. The average age of our patients was 36 with an average gesture of 3.8 and average parity of 2.5. Within the 52 patients, 42 patients (80.9%) suffered from scarred uterus and 52% underwent a vacuum aspiration. The association between scarred uterus condition and placenta previa have been found in 62% of the cases. Antenatal diagnosis haw been suspected in 77% of the cases. Metrorrhagia was the most clinically manifested. Intraplacental sonolucent space constituted the most common indication in ultrasound. The MRI corroborated furthermore the diagnosis of placenta accreta mainly in cases of posterior placenta or a suspected placenta percreta. The main term of birth was of 36 weeks. Uterine Artery Embolisation were performed for 64% of the patients and bilateral ureteric stent were used for 45% of the patients. All patients were treated by Caesarean hysterectomy. Pathological examination showed 41 cases of placenta accreta six cases of placenta increta and five cases of placenta percreta. We noticed surgical complications mainly seven bladder wounds, a ureteral trauma, hemorrhagic complications evidenced by a high rate of blood transfusions. Ten patients were hospitalised in intensive care unit. Placenta accreta is associated with a high risk of feto-maternal morbidity. Prenatal diagnosis is of para mount importance for improved patient care. Best option remains nonetheless Caesarean hysterectomy.