We read with interest the article “Risk factors for unscheduled delivery in patients with placenta accreta” by Bowman et al, where the authors address in the discussion the current controversy of timing of delivery of pregnancies with prenatal suspicion of placenta accreta (PA). Based on the results of a large cohort, they argue that it seems reasonable to consider expectant management until 36 weeks’ gestation, unless some risk factors are present. They also acknowledge that prospective multicenter cohort and randomized trials are needed to establish the optimal time for delivery of PA cases.

At Hospital Italiano de Buenos Aires, we have a multidisciplinary approach for the management of pregnancies with prenatal suspicion of PA, that includes also a scheduled delivery around 36 weeks, and we would like to contribute to the discussion with the outcomes we had experienced in a similarly large cohort. The study was approved by the institutional review board of our institution.

Of 95 cases with prenatal suspicion of PA managed in a 10-year period, 83% (79/95) had postnatal confirmation of PA. A scheduled delivery was achieved in 67% (53/79), with a mean gestational age of 36.0 ± 2.7 weeks, and an unscheduled delivery occurred in 33% (26/79), with a mean gestational age of 30.9 ± 4.5 weeks. Complications that prompted unscheduled delivery included: vaginal bleeding (n = 23), vaginal bleeding with preterm premature rupture of membranes (n = 1), preeclampsia (n = 1), and macroscopic hematuria (n = 1). Among cases with vaginal bleeding, there were 3 with massive hemorrhage that forced emergency delivery at 19, 29, and 30 weeks of gestation. Of note, admission during pregnancy was more frequent in patients with unscheduled delivery (58% vs 15%, P = .008). There were no maternal deaths.

In summary, in our series one third of the patients underwent an unscheduled delivery, mainly related to vaginal bleeding. However, most patients achieved a scheduled delivery around 36 weeks and, importantly, there were no ‘near miss’ cases because of severe hemorrhage episodes among patients delivered after 34 weeks. Therefore, with a policy of early scheduled delivery around 34 weeks, two-thirds of our cases, and half of the cases in Bowman’s series, would have been delivered 2 weeks earlier, with the increasing risks of neonatal morbidity.

Thus, even though the number of patients precludes definitive recommendations, this series also supports the rationale of a scheduled delivery around 36 weeks in the absence of risk factors.