The multidisciplinary management of placenta accreta spectrum (<scp>PAS</scp>) within a single tertiary centre: A ten‐year experience

Yasin, Nooraishah; Slade, Laura; Atkinson, Elinor; Kennedy-Andrews, Sue; Scroggs, Steven; Grivell, Rosalie M

doi:10.1111/ajo.12932

Cited by 20 publications

(25 citation statements)

References 14 publications

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“…The total incidence of PAS disorders at the study centre was comparable to other published data for tertiary perinatal centres [ 30 ], but it was higher than the pooled data of a recent meta-analysis considering studies of the last four decades [ 2 ]. One reason for this could be the increasing treatment of PAS disorders in experienced centres [ 17 ], which is recommended in the ACOG guidelines [ 22 , 24 ].…”

Section: Discussionsupporting

confidence: 72%

“…One of the two women with placenta percreta had suspected PAS, and all cases of placenta accreta were unknown. When PAS was diagnosed prenatally, this was at a median of 23 (20,30) weeks of pregnancy. The majority of diagnosis (n = 42; 91%)-prenatal and intrapartum-were made in our department.…”

Section: Resultsmentioning

confidence: 99%

“…Only in case of placenta increta or percreta, a prenatal detection was likely and a guideline-based planning of delivery management was possible. Also for the subgroup of placenta increta and percreta, a higher morbidity due to blood loss compared to placenta accreta has been demonstrated elsewhere [30]. Therefore, these cases could be more relevant when investigating the effects of the type of treatment on blood loss.…”

Section: Discussionmentioning

confidence: 97%

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Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Bluth

Schindelhauer

Nitzsche

et al. 2020

Arch Gynecol Obstet

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Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

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Section: Discussionsupporting

confidence: 72%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

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Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Bluth

Schindelhauer

Nitzsche

et al. 2020

Arch Gynecol Obstet

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“…Availability of senior colleagues or experts has been shown to improve outcome in difficult and complex cases (14). Multidisciplinary team involvement and specialized centers for managing PAS have been reporting better outcomes.…”

Section: Discussionmentioning

confidence: 99%

A comparison of antenatally and intraoperatively diagnosed cases of placenta accreta spectrum

Imtiaz

Masood

Husain

et al. 2020

J Turkish German Gynecol Assoc

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Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded. Results: During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04). Conclusion: PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome. (

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“…21 There remains wide variation in the management of accreta, both within the United States [24][25][26][27] and worldwide. 2,6,[28][29][30] However, it is well known that the use of invasive interventions, such as IR balloons and ureteral stents, is not without risk. IR balloon placement carries with it a risk of vascular injury, abscess formation, arterial thrombosis and hematoma, with rates of complications reported as high as 15%.…”

Section: Discussionmentioning

confidence: 99%

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity

2020

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Objective This study was aimed to compare clinical outcomes and use of interventions in women with suspected accreta based on the degree of antenatal suspicion. Study design This was a retrospective cohort study of women with suspected accreta from 2007 to 2019. Included patients had one or more imaging studies suggestive of accreta. Cases were classified as “lower risk” if imaging showed possible signs of accreta including mild or superficial myometrial infiltration, an abnormal uterine contour, an abnormal uteroplacental interface, or loss of the retroplacental hypoechoic zone and “higher risk” if there was clear evidence of more than superficial myometrial infiltration, placental tissue extruding beyond the uterine serosa, bridging vessel(s), or placental lacunae with high velocity and/or turbulent flow. The primary study outcome was a composite maternal morbidity including cesarean hysterectomy, transfusion of blood or blood products, unintentional cystotomy, or intensive care unit (ICU) admission. Chi-square, Fisher's exact test, and Mann–Whitney U-test were used for analysis. Results A total of 78 women had a suspected accreta on imaging, 36 with “lower risk” features and 42 with “higher risk” features. There were no differences in baseline maternal demographics. Women in the “higher risk” group were more likely to have a placenta previa (p < 0.01) and preoperative consultation with gynecologic oncology (p = 0.04). There was a significant difference in composite maternal morbidity between patients with “lower risk” and “higher risk” features of accreta on imaging (50 vs. 92.9%, p < 0.01). Median gestational age at planned and actual delivery were earlier in the “higher risk” group (36.6 vs. 34.9 weeks, p < 0.01; 36.0 vs. 34.7 weeks, p < 0.01). Conclusion Stratification of women with suspected accreta based on imaging corresponded to rates of maternal morbidity and operative complications, and appears to have been used clinically in selecting timing of delivery and interventions. Key Points

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The multidisciplinary management of placenta accreta spectrum (PAS) within a single tertiary centre: A ten‐year experience

Cited by 20 publications

References 14 publications

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

A comparison of antenatally and intraoperatively diagnosed cases of placenta accreta spectrum

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity

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