Self-reported physical, mental, and reproductive sequelae after treatment of abnormally invasive placenta: a single-center observational study
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To analyze the types of treatment of abnormally invasive placenta (AIP) and to investigate the self-reported physical and mental short- and long-term sequelae.
This single-center observational study was performed between 2003 and 2017. Women with prenatal or intrapartum diagnosis of AIP were identified through the departmental database. Classification was performed according to the time of diagnosis establishment and the type of treatment. Medical complications overall and according to the type of treatment were analyzed. Data about women’s perception of diagnosis, treatment, and short- and long-term sequelae were gathered by questionnaire.
Cases were classified into four groups: prenatal diagnosis, cesarean hysterectomy (A, n = 10); prenatal diagnosis, expectant management (B, n = 19); intrapartum diagnosis, cesarean hysterectomy (C, n = 6); intrapartum diagnosis, conservative therapy (D, n = 20). Depth of invasion, total units of transfused red blood cells, and the need for reoperation differed between the treatment groups. Expectant management was successful in 94.7% of cases. Irrespective of the treatment group, 73.3% of women perceived the condition as serious or life-threatening; 30.0% utilized psychological support; and 36.7% reported persistent pain or problems. 37.5% of women after uterine preservation had another live birth, AIP recurred in 44.4% of cases.
Conservative management of AIP is feasible in selected cases. The condition is perceived as life-threatening and has a lasting impact on the physical, mental, and reproductive health of those affected. This finding merits further investigation. AIP continues to be a condition with high morbidity.
KeywordsCesarean hysterectomy Abnormally invasive placenta Accrete Inreta Percreta Placenta Expectant management Conservative management
JW: data collection and management; data analysis; manuscript writing and editing; final approval; agreement to be accountable. M-DK-P: data collection; manuscript editing; final approval; agreement to be accountable. UG: project development; data collection and management; manuscript editing; final approval; agreement to be accountable. WMM: data collection and management, data analysis; manuscript writing and editing; final approval; agreement to be accountable.
Compliance with ethical standards
Conflict of interests
The authors declare that they have no conflict of interest.
The University Bonn Institutional Review Board does not require formal approval for retrospective observational studies, therefore, ethics approval was not sought. For the questionnaire, written informed consent was obtained from all women.
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