Conservative Management of Placenta Accreta Spectrum

Background. The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass. Conclusions. Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.

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

Journal of Medicine and Life ◽

10.25122/jml-2021-0134 ◽

2021 ◽

Vol 14 (3) ◽

pp. 367-375

Author(s):

◽

Valentin Nicolae Varlas ◽

Roxana Georgiana Bors ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Delivery ◽

Conservative Management ◽

Placenta Accreta ◽

Placenta Previa ◽

Maternal Blood ◽

Uterine Preservation ◽

Tertiary Center ◽

Placenta Accreta Spectrum ◽

The Mean

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.

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Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-018-2113-y ◽

2018 ◽

Vol 42 (3) ◽

pp. 365-370 ◽

Cited By ~ 1

Author(s):

César Hernán Meller ◽

Ricardo D. Garcia-Monaco ◽

Gustavo Izbizky ◽

Marina Lamm ◽

Jorge Jaunarena ◽

...

Keyword(s):

Cohort Study ◽

Operating Room ◽

Conservative Management ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Placenta Accreta ◽

Hybrid Operating Room ◽

Placenta Accreta Spectrum

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CLINICAL STUDY OF PLACENTA ACCRETA SPECTRUM DISORDERS IN TERTIARY CARE HOSPITAL

10.36106/paripex/7104379 ◽

2020 ◽

pp. 1-4

Author(s):

Shrinivas Gadappa ◽

Ankita Shah ◽

Rupali Gaikwad ◽

Susmita Pawar

Keyword(s):

Conservative Management ◽

Placenta Accreta ◽

Elective Surgery ◽

Placenta Previa ◽

Tertiary Care ◽

Multidisciplinary Care ◽

Care Hospital ◽

Tertiary Care Centre ◽

Placenta Accreta Spectrum ◽

Spectrum Disorders

Aims and objectives To study the range of Placenta Accreta Spectrum (PAS) disorders, management of PAS, maternal outcome in PAS and post-operative complications in patients managed either by conservative or non-conservative management. Methodology Patient were diagnosed antenatally by 2D grey scale USG (ultrasonography) as PAS 0, 1 ,2 and 3 along with colour doppler studies. The decision of conservative versus non conservative management was taken by MDT (multidisciplinary team) along with the patients and relatives and after written and informed consent and elective surgery was planned between 34-35 weeks of gestation. Results Total number of cases studied over the period of 1 year were 45. On 2D gray scale USG, PAS 0 was seen in 60% followed by PAS 3 in 17.77% and only 6.66% of PAS 2. According to weeks of gestation OH with IIAL (internal iliac ligation) was performed in 42.22 % and OH without IIAL was performed in 37.77% and 20% patients who were managed by conservative method, 6 of them needed peripartum hysterectomy. Massive transfusion protocol was activated in all the cases. Conclusion The highest risk of placenta accreta spectrum disorders are amongst women whose pregnancy is complicated by placenta previa and with a prior scar on the uterus, due to the abnormal placental implantation on the scar site. The management of PAS disorders should be at tertiary care centre along with multidisciplinary care team.

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