In the management of abnormally invasive placenta (placenta accreta spectrum), the 'conservative management' or 'leaving the placenta in situ' approach is most appropriate in which clinical scenario?
- A Percreta with bladder involvement in a patient who has completed childbearing
- B Increta confirmed on MRI in a patient who desires future fertility and is hemodynamically stable ✓
- C Accreta suspected on ultrasound in a patient at 28 weeks with uterine bleeding
- D Focal accreta in a patient with placenta previa and previous two cesarean sections
Explanation
Conservative management (intentional retention of placenta) may be considered for hemodynamically stable patients with placenta increta/accreta who strongly desire future fertility, after thorough counseling about risks including delayed hysterectomy in ~20-30% of cases, infection, and secondary hemorrhage. Percreta with organ invasion or hemodynamic instability mandates radical surgery. The recommended definitive management for most cases is planned cesarean hysterectomy at 34-35 weeks at a multidisciplinary center. Conservative approach requires close surveillance with serial MRI/Doppler.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.