<scp>FIGO</scp> consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Allen, Lisa; Jauniaux, Eric; Hobson, Sebastian; Papillon-Smith, Jessica; Belfort, Michael A.

doi:10.1002/ijgo.12409

Cited by 253 publications

(288 citation statements)

References 106 publications

(323 reference statements)

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“…Currently, patients with PAS disorder cause major concern to obstetricians, particularly since the incidence of abnormal placentation has increased significantly even among primiparous women, with reported rates ranging from 1/2510 to 1/533 births . Risks associated with any type of PAS include uncontrollable obstetric hemorrhage, emergency hysterectomy and, in very aggressive forms, urinary tract injury . Published data support the added value of MRI in the antenatal diagnosis of placental invasiveness; however, the MRI ability to predict clinical outcome of patients with suspected PAS during delivery has not yet been ascertained .…”

Section: Discussionmentioning

confidence: 65%

“…Patients with suspected PAS should undergo extensive prenatal counseling and the possibility of hysterectomy should be particularly discussed, since permanent loss of fertility is a source of emotional distress for patients who desire to preserve childbearing ability. Furthermore, it has been shown that patients' clinical outcome significantly improves when delivery is carefully scheduled and performed by a dedicated multidisciplinary team, ideally within Centers of Excellence for PAS …”

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confidence: 99%

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MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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Background Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type Prospective. Population One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence T2‐SSTSE (single‐shot turbo spin echo), T2‐TSE, T1‐TSEFS (TSE images with fat‐suppression) at 1.5T. Assessment Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5‐minute APGAR score <7. Statistical Tests Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi‐square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero‐placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5‐minute Apgar score (P = 0.078). Data Conclusion Preoperative identification of specific MRI features may predict peripartum course in high‐risk patients for PAS. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602–618.

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Section: Discussionmentioning

confidence: 65%

mentioning

confidence: 99%

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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“…Of note, it refers to a classification and not a staging system, to differentiate it from the terminology used for cancer. As an example, for use of the classification, we have summarized the recommendations of the recent FIGO guidelines for the conservative and non‐conservative surgical management of PAS according to the grade of accreta invasiveness defined in the present classification (Box ).…”

Section: Pas Grading and Classificationmentioning

confidence: 99%

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

Jauniaux

Ayres‐de‐Campos

Langhoff‐Roos

et al. 2019

Intl J Gynecology & Obste

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359

313

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Placenta accreta spectrum is impacting maternal health outcomes globally and its prevalence is likely to increase. Maternal outcomes depend on identification of the condition before or during delivery and, in particular, on the differential diagnosis between its adherent and invasive forms. However, accurate estimation of its prevalence and outcome is currently problematic because of the varying use of clinical criteria to define it at birth and the lack of detailed pathologic examination in most series. Adherence to this new International Federation of Gynecology and Obstetrics (FIGO) classification should improve future systematic reviews and meta‐analyses and provide more accurate epidemiologic data which are essential to develop new management strategies.

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“…There is also wide variation globally on the management of PAS disorders, with some centers opting for a radical approach, whereas others have proposed a range of conservative approaches . Over the last decade, there has been an increasing number of case reports, cohort studies, modeling work, and systematic reviews on the diagnosis and management of PAS disorders.…”

mentioning

confidence: 99%

FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction,

Jauniaux

Ayres‐de‐Campos

2018

Intl J Gynecology & Obste

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165

111

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FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Cited by 253 publications

References 106 publications

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction,

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