Actualidad en el diagnóstico y manejo del acretismo placentario / Update on the diagnosis and treatment of placenta accreta

El acretismo placentario es una entidad que incrementa considerablemente la morbimortalidad materna y fetal. Gracias al advenimiento de nuevos métodos diagnósticos como la resonancia magnética, la cistoscopia, los marcadores séricos, el ultrasonido doppler, etc., el diagnóstico prenatal es factible. El manejo del acretismo placentario de forma tradicional supone la realización de histerectomía multidisciplinaria, involucrando a cirujanos generales, oncoginecólogos o uroginecólogos. Algunos autores han propuesto al manejo conservador como una solución adecuada en ciertos casos, ya sea con el uso de diversos medicamentos que incluyen quimioterápicos o bien de forma expectante. Sin embargo, aún no existe evidencia sólida que determine si el manejo conservador o tradicional es el mejor.

Placenta accreta supposes a special situation that increases the fetal and maternal mo rb i mortality of considerable form. Thanks all new arrival methods as the image of magnetic resonance, the cystoscopy, serum markers, doppler ultrasound, etc., the prenatal diagnostic is feasible. The management of placenta accreta of traditional form supposes a multidisciplinary approach form hysterectomy execution, involving general surgeons, oncogynecologist or urogynecologist. Some authors have proposed the conservative management as an adequate solution in certain cases, whether with the use of several drugs including chemotherapy or expectant form. Nevertheless, not yet solid evidence exists if the surgical traditional approach or the conservative management is the best option.

Placenta Percreta

Two cases of placenta percreta are reported. Case No. 1 was presented as silent hemorrhage during the first stage of labour with dead foetus and case No. 2 was presented as acute abdomen at 36 weeks of gestation. The etiology was not known. The treatment of choice is hysterectomy, which was done for both of them