Maternal morbidity and mortality due to placenta accreta spectrum disorders

Fonseca, Andreia; Ayres-de-Campos, Diogo

doi:10.1016/j.bpobgyn.2020.07.011

Cited by 50 publications

(44 citation statements)

References 76 publications

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“…Owing to the rising trend of cesarean deliveries, incidence of PAS has increased by approximately 100 times compared with when it was first described 2 . PAS is associated with 18‐fold increase in maternal morbidity and may be associated with up to 30% mortality rate, particularly when prenatal diagnosis is missed 3,4 …”

Section: Introductionmentioning

confidence: 99%

“…2 PAS is associated with 18-fold increase in maternal morbidity and may be associated with up to 30% mortality rate, particularly when prenatal diagnosis is missed. 3,4 Cesarean hysterectomy, with placenta in situ, has been the safest and most acceptable procedure for management of PAS as it obviates the massive blood loss associated with manual removal of the placenta. 5 However, because patient motivation to preserve the uterus is not uncommon in these situations, several uteruspreserving procedures have been invented and adopted worldwide with variable results.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of success of uterus‐preserving management in women with placenta accreta spectrum (CON‐PAS score): A multicenter international study

Shazly

Hortu

Shih

et al. 2021

Intl J Gynecology & Obste

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Objective To create a model for prediction of success of uterine‐preserving procedures in women with placenta accreta spectrum (PAS). Methods PAS‐ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. Results Out of 797 women with PAS, 587 were eligible. Uterus‐preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001–3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05–0.43), type of CS incision (aOR 0.04, 95% CI 0.01–0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00–6.16), accreta type (aOR 3.76, 95% CI 1.13–12.53), incising away from placenta (aOR 5.09, 95% CI 1.52–16.97), and uterine resection (aOR 102.57, 95% CI 3.97–2652.74). Conclusion The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of success of uterus‐preserving management in women with placenta accreta spectrum (CON‐PAS score): A multicenter international study

Shazly

Hortu

Shih

et al. 2021

Intl J Gynecology & Obste

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“…Early reports on placental implantation abnormalities have estimated maternal mortality rates of approximately 7%, reaching 30% in the absence of prenatal diagnosis. Recent data suggest that mortality rates in the range of 0.05% are achievable when prenatal diagnosis and multi-professional expert management are available [10,11]. The clinical outcomes of placental implantation abnormalities are directly related to the depth and topography of the placenta.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Prophylactic Internal Iliac Artery Balloon Occlusion (Iiabo) in Placental Implantation Abnormalities

López-Benítez

Castillo

Hodel

et al. 2021

Preprint

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BackgroundPlacental implantation abnormalities remain among the major causes of massive postpartum hemorrhage and maternal mortality worldwide. To avoid a hysterectomy, prophylactic management with perioperative internal iliac artery balloon occlusion (IIABO) could minimize blood loss and facilitate surgical performance through reductions in the rate of uterine perfusion. We aimed to evaluate the safety and efficacy of IIABO in patients with placental implantation abnormalities.ResultsThe study group consisted of 13 patients, including three patients with placenta previa totalis, seven patients with placenta increta, and three patients with placenta percreta. Prophylactic IIABO was performed in all patients. The median estimated blood loss was 700 ml ± 598.8 ml, the median number of red blood cell transfusion units was 0 ± 0.75, and only two patients required uterine artery embolization. The uterus was preserved in eight patients (61.5%), with an average intra-hospitalary stay of 6 ± 3.2 days. The average fetal radiation dose was 4.67 mGy. No complications were attributed to IIABO placement.ConclusionsThe prophylactic use of IIABO in placental implantation abnormalities is an effective and safe method of controlling perioperative bleeding during cesarean section and hysterectomy. Indications should be strictly controlled, and interdisciplinary planning and management are mandatory.

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“…PAS is associated with significant maternal morbidity including massive obstetric haemorrhage, coagulopathy, ICU admission, mechanical ventilation, infection, and prolonged hospitalization. Maternal mortality reaches 30% in some reports (4).…”

Section: Introductionmentioning

confidence: 97%

Uterus Preservation Versus Caesarean Hysterectomy in Management of Placenta Accreta Spectrum: A Multicentre International Study

Shazly¹,

Hortu

Shih

et al. 2021

Preprint

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Objective: To compare peripartum outcomes of uterus preserving procedures to caesarean hysterectomy in women with placenta accreta spectrum (PAS), and to identify risk factors associated with adverse maternal outcomes. Design: Retrospective study (ClinicalTrials.gov identifier: NCT04384510) Setting:11 tertiary centres from 9 countries Population or Sample: women with of PAS who were managed in participating centres between January 1st, 2010 and December 31st, 2019. Women who had confirmed diagnosis with PAS with adequate documentation and follow-up, were considered eligible. Main Outcome Measures: Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Results: Out of 797 women, 727 were eligible for the study. Five hundred ninety-two (81.43%) women were managed by uterus preserving procedures versus 135 (18.56%) who underwent caesarean hysterectomy. After adjustment for significant or close-to-significance variables, type of management was not associated with higher risk of massive blood loss (aOR 1.71, 95% CI 0.78 - 3.81). Other factors that were significantly associated with higher risk of massive PAS-associated blood loss included body mass index, preoperative haemoglobin, centrally located placenta, diffuse placental invasion, parametrial invasion, and intrauterine foetal death. Conclusions: In the presence of sufficient experience, uterus preserving procedures may not be associated with higher risk of massive blood loss compared to caesarean hysterectomy. Funding: none

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Maternal morbidity and mortality due to placenta accreta spectrum disorders

Cited by 50 publications

References 76 publications

Prediction of success of uterus‐preserving management in women with placenta accreta spectrum (CON‐PAS score): A multicenter international study

Prediction of success of uterus‐preserving management in women with placenta accreta spectrum (CON‐PAS score): A multicenter international study

Perioperative Prophylactic Internal Iliac Artery Balloon Occlusion (Iiabo) in Placental Implantation Abnormalities

Uterus Preservation Versus Caesarean Hysterectomy in Management of Placenta Accreta Spectrum: A Multicentre International Study

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