Placenta Previa and Accreta : Gestational age for delivery

Abstract

Background: Placenta accreta is increasing in frequency; likely because of the increased frequency of cesarean delivery. Aim: To compare strategies for the timing of delivery in individuals with placenta praevia and ultrasonographic evidence of placenta accreta, and to determine the optimal gestational age at which to deliver individuals. Materials and methods: A decision analytical model was designed using DATA 3.5 software that compared SIX different strategies for the timing of delivery of individuals with ultrasonographic evidence of placenta praevia with accrete on the basis of Published Data. Results: The strategy that provides the highest total quality-adjusted life years for the maternal-fetal dyad is delivery at 34 weeks of gestation after administration of antenatal corticosteroids. Conclusion: A scheduled delivery at 34 weeks of gestation was the preferred strategy and resulted in the highest quality-adjusted life years under the base case assumptions. After sensitivity analyses, delivery at 37 weeks of gestation without amniocentesis was the preferred strategy in limited situations, and delivery at 39 weeks of gestation was the preferred strategy only in unlikely situations.