Conservative Management of Placenta Percreta: Three Cases and a Review of the Literature regarding Conservative Management of Placenta Accreta Spectrum (PAS) Disorders.

Abstract

Background. The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass. Conclusions. Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.

Hysterectomy after a failed conservative management of placenta increta: A case report

“…Prenatal diagnosis and diligent follow-up using routine ultrasound imaging complemented with MRI in suspicious cases are required to avoid emergent surgical complications. Conservative management of placenta accreta is a new presented approach to evade hysterectomy complications and preserve fertility by leaving the placenta in situ after the delivery of the fetus [4] . Although conservative management success rates ranged from 60% and 85%, it is associated with risk of endometritis, sepsis, disseminated intravascular coagulation (DIC), and late perinatal hemorrhage [7] .…”

“…Management of PAS can be achieved through cesarean hysterectomy, extirpative, or conservatively [3] . Although hysterectomy is the gold standard of management, conservative management by leaving the placenta in situ can be applied; either after a failed attempt to remove the placenta manually or without any previous attempts [2] , [4] . Conservative management of PAS is associated with a decline in morbidity and mortality rates together with the demand for a massive blood transfusion [4] .…”

“…Although hysterectomy is the gold standard of management, conservative management by leaving the placenta in situ can be applied; either after a failed attempt to remove the placenta manually or without any previous attempts [2] , [4] . Conservative management of PAS is associated with a decline in morbidity and mortality rates together with the demand for a massive blood transfusion [4] . However, leaving the placenta in situ may have some concerns regarding its subsequent complication as it requires a multidisciplinary follow-up involving the patient and surgeon by using the appropriate investigation methods at the appropriate time.…”

Validity of Internal Iliac Artery Ligation with Cervico-Isthmic Compression Suture During Conservative Management of Placenta Accreta Spectrum

“…There are methods to manage PAS such as cesarean hysterectomy (CS hysterectomy) and conservative treatment which includes a stepwise approach, cervico isthmic compression suture, and Triple-P procedure (2) . Vessels' ligation could be utilized as a part of traditional management concerning PAS management to reduce blood loss as uterine artery ligation (UAL) and IIAL.…”

Placenta Accreta Spectrum: Conservative Management and Its Impact on Future Fertility

“…13,15,18 The progressive decrease in blood supply to the uterus after delivery results in placental necrosis and detachment, followed by placental resorption and expulsion. 19 However, this method is associated with a morbidity rate of 56%-87.5%, and complications such as postpartum hemorrhage, infection, sepsis, disseminated intravascular coagulation, delayed hysterectomy, uterine arteriovenous fistula, and choriocarcinoma. [19][20][21][22] The extirpative method…”