Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature

Abstract

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was
the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal
diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to
01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta
accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta
previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly
suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta
accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving
the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with
adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is
an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest
International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our
center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.