Leslie Moroz

Discussion: ‘The interleukin-10 gene and cervical insufficiency’ by Warren et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Warren JE, Nelson LM, Stoddard GJ, et al. Polymorphisms in the promoter region of the interleukin-10 (IL-10) gene in women with cervical insufficiency. Am J Obstet Gynecol 2009;201:372.e1-5.

97 – Placenta Accreta

The rising rates of cesarean delivery in recent years have led to an increase in the diagnosis of placenta accreta, increta, and percreta. A high index of suspicion and prenatal imaging are critical for identifying patients at risk and planning for delivery. A diagnosis of placenta accreta should be considered in all women with any of the following: prior cesarean delivery, placenta previa or low-lying placenta and a history of prior uterine surgery, Asherman syndrome, endometrial ablation, or pelvic radiation. Women with risk factors should undergo a targeted US assessment for possible placenta accreta in the midtrimester. Transabdominal and transvaginal US can be further enhanced by use of Doppler imaging and potentially three-dimensional (3D) imaging. Magnetic resonance imaging (MRI) may be used adjunctively in certain conditions. When accreta is suspected, the patient should be counseled about potential morbidity and the possibility of hysterectomy. Delivery by a multidisciplinary team at a high-volume center or accreta center of excellence is recommended.