Abordarea diagnostică şi terapeutică a placentei invazive

Adherent placenta incidence has increased in the last 60 years from 1/30000 pregnancies to 1/700 pregnancies. The increased index of the caesarean section supports this pathology. Uncontrollable bleeding due to the invasive placenta is one of the main indications of per partum hysterectomy and a major cause of disseminated intravascular coagulopathy, adult respiratory distress syndrome, kidney failure and maternal mortality. Although ultrasound diagnosis has a sensitivity considered to be 90% and a specificity of 97% with a positive real rate appreciated at 11 and a negative real rate of 0.16, magnetic resonance imaging is widely available and has a high diagnostic accuracy. In current practice prevails an inadvertently and an unreasonably high report between prenatal and the intraoperative diagnosis. Discussing the cases from the last 2 years of experience in a multidisciplinary emergency hospital, we present a broad review of the literature with the purpose of giving a coherent and standardized approach of the patients with risk factors. As well, the current methods for optimal therapeutic approach will be presented.