Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Abstract

Background Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A) , ( n = 38) underwent cesarean hysterectomy, group (B) , ( n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C) , ( n = 16): the placenta was left in place. Results The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Trial registration Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Cesarean Scar Defect Manifestations during Pregnancy and Delivery

“…As a result, more placental implantation pathologies occur [26], and certainly more problems related to scar dehiscence following repeated pregnancies following Cesarean Sections.…”

A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup

“…Cervix as natural tamponade (by inverting the anterior or posterior lip of the cervix and suturing with the placental bed in the anterior or posterior wall of the uterus) was also reported from Egypt as safe, simple, time-saving and effective method for controlling PPH caused by placenta previa or placenta previa accreta (48). The same authors reported cervical tamponade with bilateral uterine artery ligation and removal of the placenta after a month on elective base as a safe alternative method to hysterectomy in those women who wish to preserve their fertility (49). In general, the devascularization procedures in option IV are not limited to the bilateral anterior division of internal iliac artery ligations like Shabana and colleagues 'stepwise approach', it entertains multiple alternative modalities.…”

“…Large case series studies (which had included >30 cases of expectant management) are summarized in Table 1 (18,20,40,42,44,49,62,60,61,63,64) to show the outcomes of uterine preserving interventions. As there were plenty of success stories in non-percreta cases, in terms of avoiding hysterectomy, there were also failures, primarily due to serious complications requiring immediate and delayed hysterectomy.…”

Systematic Identification of Hub Genes in Placenta Accreta Spectrum Based on Integrated Transcriptomic and Proteomic Analysis

“…The prevalence of PAS has increased about eight times since 1970s ( Silver and Branch, 2018 ). A study showed that the overall proportion of PAS in recent years had even reached 0.91% ( El Gelany et al, 2019 ).…”