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Master Thesis

Troubles de l'invasion placentaire : intérêt d'un dépistage anténatal et place du traitement conservateur

Abstract : Abnormal placental invasion, more or less severe, are linked to a decidual alteration. In antenatal screening, those complications can be detected by ultrasound and magnetic resonance. However, in half of the cases, those disorders are discovered incidentally only during delivery. The conservative treatment, consisting in leaving partially or totally the abnormal placenta in situ, seems to be a good alternative to immediate hysterectomy. The aims of this study were to evaluate the benefits of abnormal placental invasion antenatal screening, as weel as the short and medium term morbidity of conservative treatments, depending on the severity of those disorders. A retrospective study was performed on 47 cases of confirmed abnormal placental invasion which had a conservative treatment between 2001 and 2012 at the Port Royal Maternity. Those 47 cases included 29 placenta accreta, 1 placenta increta and 17 placenta percreta. Twenty-four (51,4%) patients benefited from antenatal screenning including the most severe cases (17 placenta percreta). Among them, 76,5% of women with placenta percreta had a secondary hysterectomy secondarily (13/17) compared to 14,3% of those with placenta accreta (1/7). The two main indications for hysterectomy were hemorrhage and infection. None of the 23 patients who had no antenatal screening had secondary hysterectomy and all had simple placenta accreta. The long term complications, such as sepsis, renal failure, phlebitis and pulmonary embolism, concerned 85,7% of women with initial placenta percreta. Among the 30 patients with placenta accreta or increta, only two had complications after conservative treatment. In conclusion, conservative treatment seems to be a good option in less severe forms of placental invasion disorders (accreta and increta), and would not be responsible for a high maternal morbidity in these women. On the other hand, larger studies are needed to study the link between conservative treatments and the absence of subsequent morbidity.
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  • HAL Id : dumas-01056697, version 1

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Pauline Charpak. Troubles de l'invasion placentaire : intérêt d'un dépistage anténatal et place du traitement conservateur. Gynécologie et obstétrique. 2014. ⟨dumas-01056697⟩

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