Accurate prenatal discrimination of placenta accreta spectrum from uterine dehiscence is necessary to ensure optimal management

Uterine scar dehiscence with underlying placenta is often misdiagnosed as placenta accreta spectrum both prenatally and intraoperatively due to the absence of myometrial tissue in the area. Misdiagnosis generates obstetric anxiety and results in overtreatment which carries a risk of iatrogenic injury. We present a case of the antenatal diagnosis of uterine dehiscence in a 36-year-old woman with a history of two caesarean deliveries and a low-lying placenta. We further describe the sonographic features useful for differentiating this condition from placenta accreta spectrum in instances where the placenta lies under an area of full thickness uterine scar dehiscence.

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Clinical outcomes of a false positive antenatal diagnosis of placenta accreta spectrum

American Journal of Perinatology ◽

10.1055/a-1673-5103 ◽

2021 ◽

Author(s):

Bahram Salmanian ◽

Amir A. Shamshirsaz ◽

Karin Fox ◽

nazlisadat meshinchi asl ◽

Hadi Erfani ◽

...

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

False Positive ◽

Maternal Morbidity ◽

Placenta Accreta ◽

Antenatal Diagnosis ◽

Estimated Blood Loss ◽

Management Protocol ◽

Significant Difference ◽

Placenta Accreta Spectrum

Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

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Placenta Accreta Spectrum: A preventable nearly iatrogenic disorder.

10.32512/jmr.3.2.2020/24.25 ◽

2021 ◽

pp. 24-25

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Uterine Wall ◽

Subsequent Pregnancy ◽

Team Approach ◽

Fetal Life ◽

Risk Increase ◽

History Of ◽

Placenta Accreta Spectrum ◽

Threatening Situation

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. PAS disorder is a maternal and fetal life-threatening situation due to the high risk of intrapartum uncontrollable bleeding. The common described risk factors are the placenta previa and history of Caesarean section (CS) [1]. We herein report our experience with five patients referred to our department for suspected PAS. These patient were selected for targeted prepartum ultrasound assessment due to their history of multiple C-sections. PAS risk increase with the number of previous CS and could reach7% [2]. In Nicaragua , the rate of c-section in obstetrical practice is still high and approximating 40% in some centers. Uterine wall dehiscence result in locally defective decidualisation and abnormal placental adherence with important trophoblastic invasion in a subsequent pregnancy [3]. We still believe that this disorder is preventable if we “go back” a little to obstetrical good practices. Dramatic situations can be avoided by selecting suspected PAS on ultrasound or MRI to be referred. PAS is the commonest cause of intrapartum hysterectomy and must be managed always in specialized centers with multidisciplinary team approach.

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