Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach

Objective: The aim of this retrospective cohort study was to evaluate maternal and neonatal outcomes in patients with placenta previa (PP) and placenta accreta (PA). Methods: The study population comprised all patients who had a cesarean section for PP and PA at a tertiary referral hospital in Taif, Kingdom of Saudi Arabia, from December 2009 to December 2012. Maternal and neonatal data were obtained from medical records and the hospital database system. PA cases were managed by a multispeciality team, including two obstetric consultants. Results: In total, 122 patients with PP were identified, with PA found in 25 cases. The median intraoperative blood loss in cases of PA was 2,000 (mean 3,000) mL, with a loss of >= 2,000 mL occurring in 72%, and > 5,000 mL in 20%. The median packed red blood cell transfusion requirement was 6 (mean 7.7) units, and 28% received >= 10 units. Fetal growth restriction was diagnosed in two cases with known maternal medical disorders. Four cases (3.3%) were diagnosed as small for gestational age. The mean birth weight of the neonates was at the 10th-50th percentile according to Hadlock fetal growth charts. Conclusion: The presence of a second obstetric consultant among the multispeciality team during surgery for PA was associated with a reduction in blood loss and a decreased need for large-volume blood transfusion. The rate of fetal growth restriction/small for gestational age in PP was average, but the babies were relatively small (level 2 evidence).