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RESEARCH POSTER PRESENTATION DESIGN 2012
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Placenta accreta is a rare and pontentially life threatening
complication of pregnancy, which is characterized by abnormal
adherence of the placenta to the uterine wall.
Patients with placenta accreta are in high risk of potentially life
threatening post partum hemorrhage.

Introduction
The association of placenta previa and prior cesarean
delivery with placenta accreta as a cause of emergency
peripartum hysterectomy have been well documented.
Emergency peripartum hysterectomy remains a potentially
life-saving procedure with which every practitioner of
obstetrics must be familiar.
Informed consent obtained from the patient scheduled for
the elective cesarean section would have to include
information about the increased risk of placenta previa,
placenta accreta as life threathing complication in the
subsequent pregnancies.
1. Eshkoli T, Weintraub AY, Sergienko R,Sheiner E. Placenta accreta: risk factors, perinatal
outcomes, and consequences for subsequent births. Am J Obstet Gynecol
2013;208(3):219.e1-7.
2. Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KF, Laky
C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete
placenta previa is characterized by reduced systemic levels of vascular endothelial
growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast.
Am J Obstet Gynecol 2011;204(5):411.e1-11.
3. Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN, Simpson LL, Gaddipati S,
Sun X, D'Alton ME, Devine P. Predictors of massive blood loss in women with placenta
accrete. Am J Obstet Gynecol 2011;205(1):38.e1-6.
4. Stirnemann JJ, Mousty E, Chalouhi G, Salomon LJ, Bernard JP, Ville Y. Screening for
placenta accreta at 11-14 weeks of gestation. Am J Obstet Gynecol 2011;205(6):547.e1-
6.
5. Clark AS, Silver RM. Long-term maternal morbidity associated with repeat cesarean
delivery. Am J Obstet Gynecol 2011;205(6):S2-S10.
6. Belfort MA, Society for Maternal-Fetal Medicine, Publications Committee. Placenta
accrete. Am J Obstet Gynecol 2010;203(5):430-439
7. Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical management of
placenta accreta: a cohort series and suggested approach.
Am J Obstet Gynecol 2010;202(1):38.e1-9.
8. Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, Moore TR,
Ramos GA. Preoperative intravascular balloon catheters and surgical outcomes
in pregnancies complicated by placenta accreta: a management paradox.
Am J Obstet Gynecol 207(3);216.e1-5.

Prof. dr Ljiljana Mirkovi
Clinic for Gynecology and Obstetrics, Clinical Center of Serbia,
Serbia
drljiljamirkovic@gmail.com
+381 63 633 780
Retrospective analaysis was conducted on deliveried women
between the years 2007 2012 at the Clinic for Gynecology and
Obstetrics, Clinical Center of Serbia. All the cases of placenta
accreta, incretta, percretta was confirmed by hystopathology
conclusion.
Data regarding demographic characteristics, number and mode of
previus deliveries, obstetrical risk factors and the performming
of emergency peripartum hysterectomy were collected from
hospital charts.
The SPSS softwere package was used for statistical analysis.
Univariate and multivariate analysis were performed by stepwise
logistic regression.

Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia
Author : Ljiljana Mirkovi
Coauthors : Uro Ravili, Tijana Janji, Radmila Spari, eljka Rali
Placenta accrete. Incidence and risk factors
0
5
10
15
20
25
30
35
40
2006 2007 2008 2009 2010 2011 2012
Materials and Methods
Objectives
Results
Conclusions
Contact
The objective of the study was to examine the incidence and risk
factors for the occurrence of placenta accreta, incretta, percretta
in the setting of the large tertiary center with average of 7000
deliveries annually.

References
During the study period, there were 47 541 deliveries of
which 33 487 were transvaginal and 14 054 (29,56%) by
cesarean section. Calculated incidence of placenta accreta,
incretta, percretta was 0,19 per 1000 deliveries.

Placenta accreta as complication was found in 9 cases
(0,06%) of total number of the caesarean sections.
All patients with placenta accreta were delivered by
cesarean section.

Emergency peripartum hysterectomy was performed in all
of the patients due to significant hemorrhage.
During the studied period there were 52 peripartum
hysterectomies, and placenta accreta were indication for
the peripartum hysterectomy in 17,3% cases.

The following parameters were found to independently
influence the risk of the occurrence of placenta accreta in
our study: previous cesarean section (OR 8,34; 95% CI 1.73
40.17, p < 0,001), age of the patient > 35 years (OR 4,34;
95% CI 0,01 34,41, p < 0,001, and placenta previa (OR
22,91; 95% CI 1,33 393,79; p < 0,001).

24,8% 24,2%
27,6%
30%
32,2%
34,1%
34,2%
Year
C
e
s
a
r
e
a
n

S
e
c
t
i
o
n

(
%
)

Previous SC
Odds ratio
Patient Age >35
Placenta Previa
Odds ratio
Odds ratio
0.001 0.01 0.1 1 10 100 1000
1 10 100 1000
0.001 0.01 0.1 1 10 100 1000
Previous SC
Patient Age >35
Previous SC
Placenta Previa