Placenta accreta: changing clinical aspects and outcome.

In an effort to determine if a changing clinical picture for placenta accreta exists in the late 1970s, 22 cases from January 1, 1975, to May 30, 1979, at Los Angeles County/University of Southern California (LAC/USC) Medical Center were reviewed. An incidence of clinically diagnosed placenta accreta of 1 per 2562 deliveries for all cases and 1 per 4027 for pathologically confirmed cases (ie, hysterectomy specimens) was found. Mean age of the patients was 29.5 years, and mean gravidity, parity, and abortion were 3.4, 2, and 0.27, respectively. Placenta previa was found in 14 patients (63.6%), 6 of whom had previously undergone cesarean section. No obvious etiology was found in 1 patient. Sixteen patients underwent cesarean section. Hysterectomy was performed on 14 patients, and conservative measures were employed in 8 patients. One maternal death (4.5%) occurred, but there was no perinatal mortality. The clinical picture of placenta accreta today is one of higher reported incidence, lower parity, greater incidence of associated placenta previa, individualized management, and decreasing maternal and perinatal mortality.