A review of the clinical decisions, diagnostic, and surgical methods in managing patients with placenta percreta was done by conducting a MEDLINE computerized search from January 1991 to January 1997 using the key words "placenta percreta," "placenta previa," "acute normovolemic hemodilution," and "erythropoietin use." Additional sources were identified through cross-referencing. We reviewed all published reports and articles regarding the clinical and surgical management of placenta percreta and nontraditional ways to treat or prevent anemia in these cases (including acute normovolemic hemodilution and erythropoietin use). The diagnosis of placenta percreta using different ultrasonographic criteria is reliable. Clinical and surgical methods of managing placenta previa with a high risk of percreta are all based on prevention of uncontrolled hemorrhage. Ninety percent of these patients will lose more than 3000 ml intraoperatively and will require blood transfusion. To avoid serious maternal morbidity secondary to hypovolemia, several options are available: erythropoietin use, acute normovolemic hemodilution, selective arterial embolization, prophylactic uterine, or hypogastric artery ligation. With the increasing incidence of placenta percreta, the clinician must use all available methods to accurately diagnose this condition. Adequate preparation and good surgical technique will help reduce maternal mortality and morbidity related to this condition.
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