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March 01 2001 • Volume 36 • Number 5

Obstetrics

Maternal mortality is 7%
Cesarean Rate Portends Rise in Placenta Accreta

Timothy F. Kirn

BEAVER CREEK, COLO. — The rise in the cesarean rate over the last several years may portend an increase in the incidence of placenta accreta, Dr. Richard P. Porreco warned at a perinatal conference sponsored by the University of California, Irvine.

"I think that with the cesarean rate what it is we are creating a potentially very great problem downstream," Dr. Porreco, medical director of the perinatal unit at Presbyterian-St. Luke's Medical Center, Denver, said in an interview. According to one large survey, the cesarean rate in 1999 was 21%, up from 12% in 1972.

The maternal mortality rate with placenta accreta is 7%. Placenta accreta is related to placenta previa and to previous cesarean section. A woman with two prior cesareans has a 60% risk of having a placenta accreta with a placenta previa, and a woman who has had four cesareans has a 70% risk of placenta accreta, increta, or percreta.

Even when physicians are prepared and well equipped, the condition can be extremely dangerous, Dr. Porreco said. Recently at his institution a 37-year-old woman, who had undergone three previous cesareans, was diagnosed with placenta previa and percreta at 30 weeks' gestation by ultrasonography. At 34 weeks' gestation she underwent an abdominal hysterectomy and bladder resection.

Although the physicians were ready—and even had artery balloon catheters prepositioned before beginning and a team of surgeons on hand—the patient ended up going into cardiac arrest during the procedure and had postoperative complications that kept her in the hospital for 20 days.