الفهرس 
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Abstract
Placenta accreta is an extremely serious complication in pregnancy. It occurs when the placenta invades more deeply than normal, into the wall of the uterus (placenta accreta), and sometimes even growing through the full thickness of the wall to the outside of the uterus (placenta increta or percreta)
Abnormal placental invasion (placenta accreta) can result in major obstetric hemorrhage during delivery. The most important risk factors are the following: previous cesarean delivery, placenta previa, maternal age over 35, smoking, previous myomectomy, dilatation and curettage. Ascribing to the trend of rising cesarean delivery rates in the last decades, placenta accreta has become the most important cause of peripartum hysterectomy.
When placenta accreta is suspected on ultrasound, and MRI can complete the diagnostic. Therefore, patients must be managed, as far as possible, in a reference centre, by a trained medical team. Birth must be planned in order to decrease complications rate.
Treatment can consist in radical management (cesarean-hysterectomy) or conservative management (preservation of both uterus and placenta by leaving placenta in place followed by medical treatment or lapartomy ) or extirpative management approach by trying manual removal of placenta from the uterus but this has a great risk of massive bleeding and may lead to permanent loss of fertility, it can be tried in women who had completed their families .
Conservative management (by leaving placenta in place)allows patients to keep fertility but can also decrease blood loss during delivery. Side effects of this therapy are secondary hemorrhage, sepsis and long-term follow-up. There are few studies describing fertility after conservative management, but it seems to be a secure treatment for future pregnancies. Uterine artery embolization can be a very useful, already demonstrated, help when massive hemorrhage occurs.
Management of placenta accreta is multidisciplinary and patients must be informed of all options. Treatment is decided regarding history of the patients, operative findings and peri-partum blood loss.
Our study that was conducted in maternity unit of Minia University Hospital during the period from March 2019 to February 2020. The study include 150 cases, those cases attended to our university hospital and diagnosed as placenta accreta with history of previous uterine surgery mostly previous cesarean section. In thirty nine cases; cases underwent cesarean hysterectomy placenta didn’t separated at all (diffuse accreta or percreta) or placental bleeding was excessive, but 111 cases, uterus was preserved ( either placenta separated partially, so the remaining portion is removed and bleeding from placental bed was dealt with cervical inversion +/- intra uterine packing or if the placenta didn’t separated, the placenta left in place and followed by lapartomy after a while to minimize bleeding)