Placenta accreta is a life-threatening obstetrical condition. Prenatal prediction of placenta accreta helps to minimize clinical complications. Placenta previa is one of the most important factors associated with placenta accreta. In our prospective cohort study, ultrasound finding of loss of the retroplacental hypoechoic clear zone was found to be a single predictor of placenta accreta in women with placenta previa (odds ratio, 15.6; 95% confidence interval, 2.1–114.6; p < 0.01). In addition, we have devised a novel scoring system for predicting placenta accreta in pregnancy with placenta previa, yielding 91.3% sensitivity, 98.0% specificity, 87.5% positive predictive value, and 98.7% negative predictive value. Planned preterm cesarean hysterectomy with the placenta left in situ is generally recommended for women with suspicion of placenta accreta. If the women have a desire for future fertility, conservative approach may be considered.
Part of the book: Placenta