الفهرس 
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Abstract
This audit aims to compare the management of placenta accreta to the standard guidelines or published reports were performed. Also it aims to Identify gap between current practice and guideline and to set recommendations for filling gap to improve outcome. Our study auditing the management of placenta accreta regarding maternal and fetal outcome against the standard guidelines. Our study included 96 cases admitted to Women’s Health Hospital, Assiut University, all were diagnosed before delivery. The average gestational age at delivery was 37 weeks. 84 cases had uterus preserving surgery while 12 had peripartal hysterectomy. The average blood loss was more in cases underwent peripartal hysterectomy (2.2 L) than those who had uterus preserving surgery (1.8 L). The average intraoperative transfused blood units is more in peripartal hysterectomy (4 units) than uterus preserving surgery (2 units). Also the percentage of urinary bladder injury was more in peripartal hysterectomy (41%) than uterus preserving surgery(19%).Postoperative ICU admission was more in peripartal hysterectomy (50%) than uterus preserving surgery (3.6%).6 out of 95 liveborn were admitted to NICU due to prematurity (delivered at 34 weeks or less) and congenital anomalies with one stillbirth. Placenta accreta is becoming a more common complication of pregnancy. Prenatal diagnosis is important in optimizing the counseling, treatment, and outcome of women with placenta accreta. The most important risk factor for PAS is placenta previa after a prior cesarean delivery. PAS occurs in 11 percent of women with a placenta previa and one previous cesarean delivery. The risk increases substantially with increasing numbers of prior cesareans. Previous gynecologic uterine surgery is also a risk factor that should be considered, particularly among primigravidas. Women with a placenta previa or a low anterior placenta and prior uterine surgery should have thorough transabdominal and transvaginal sonographic evaluation of the interface between the placenta and myometrium between approximately 18 and 24 weeks of gestation. At this gestational age, the prenatal diagnosis of PAS can be made or ruled out with close to 90 percent accuracy. The diagnosis can be reasonably excluded when imaging studies suggest normal placental implantation. (Bailit JL et al 2015) It is critical to develop a plan preoperatively for managing women with a high likelihood of placenta accreta spectrum (PAS). The plan should involve a multidisciplinary team and scheduled delivery in a facility with resources and personnel to manage massive hemorrhage and complicated pelvic surgery. If the clinician does not manage patients with PAS routinely, these patients should be referred to a center with experience and expertise. Surgical treatment for placenta accreta is commonly performed as hysterectomy. However, conservative management should be the preferred approach especially for pregnant women who want to retain their future fertility and not accepting hysterectomy after extensive counseling regarding risks. In this audit, we have presented uterus preserving management versus C.S hysterectomy regarding maternal and fetal outcome. Future studies on: Optimal timing of delivery for both conditions (placenta praevia and placenta accreta) are needed. Surgical and nonsurgical management strategies for placenta accreta spectrum The diagnosis and management of placenta accreta spectrum should use a standardised evidence-based approach, including systematic correlation between ultrasound signs and detailed clinic diagnosis at delivery, and pathologic confirmation of grades of villous invasiveness where possible.