Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center

Abstract

Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.

A Retrospective Study of Maternal and Neonatal Outcome in Placenta Accreta Spectrum After Planned or Emergency Delivery From a Tertiary Care Centre in North India

“…Similarly in a UK-based descriptive study, one of the 20 unsuspected patients with placenta praevia and a prior caesarean section was found to have no ultrasound signs of a morbidly attached placenta [ 15 ]. The range of ultrasonography's positive predictive value for placenta accreta is between 65% and 93% [ 6 ]. For this reason, it is advised to postpone any surgical intervention until the placenta spontaneously separates after the baby is delivered.…”

“…Hysterectomy was performed in 87.5% of cases in our study. Similarly, hysterectomy was performed in 91.6% of cases in a study from a tertiary centre [ 6 ]. Conservative or expectant management should be considered only for carefully selected patients with PAS after thorough counselling regarding the dangers, unknown benefits, and efficacy [ 16 ].…”

“…Methotrexate and arterial embolization are not recommended currently since studies have not demonstrated their effectiveness in lowering these risks [ 6 ]. Recently, the practice of inserting inflatable balloons into the pelvic arteries, typically in the anterior divisions of the internal iliac arteries, gained popularity.…”

Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries

“…The desire of some patients to maintain their fertility has led to conservative treatment. Bakri balloon placement, segmental myometrial resection, placental bed suturing, uterus-sparing surgery [ 7 ], and long-term postpartum follow-up after leaving the placenta in place in cases of advanced invasion are among the current management options [ 8 , 9 ]. The success rate of uterus-sparing surgery is reportedly 78.4–80.0% in the literature [ 10 – 12 ].…”

Use of ureteral catheter in uterine-sparing surgery for placenta accreta

“…[4,5] The most crucial risk factor in the development of PAS is placenta previa after cesarean section (C/S). [6] A pregnant woman with a previous diagnosis of placenta previa has a 60% risk of PAS in her next pregnancy. [7,8] An appropriate evaluation should be made in PAS cases by interviewing the families before birth.…”