A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum

• DOI: 10.1111/aogs.14096
• Publication Date: 2021-01-23T09:48:19Z
• Authors: Heleen J. van Bee...; Vedran Stefanovic; Alexander Schwickert; Wolfgang Henrich; Karin A. Fox; Mina MHallem Gziri; Loïc Sentilhes; Lene Gronbeck; Frederic Chantraine; Oliver Morel; Charline Bertholdt; Thorsten Braun; Marcus J. Rijken; Johannes J. Duvekot
• Keywords: Placenta Accreta; Placenta previa; Placenta Diseases

Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving in situ subsequent reabsorption or delayed hysterectomy, manual removal after vaginal delivery during cesarean section, focal resection affected uterine wall, and peripartum hysterectomy. The aim this observational study was to describe actual clinical management outcomes PAS a large international cohort.Data from 15 referral centers International Society (IS-PAS) were analyzed correlated classification IS-PAS: From Grade 1 (no PAS) 6 (invasion into pelvic organs other than bladder). usually diagnosed antenatally operators performing ultrasound rated likelihood on Likert scale 10.In total, 442 registered database. No maternal deaths occurred. Mean blood loss 2600 mL (range 150-20 000 mL). Placenta previa present 375 (84.8%) there history previous 329 (74.4%) women. score strongly grade (P < .001). mode majority (n = 252, 57.0%) repeat laparotomy 20 (7.9%) due complications. In 48 (10.8%), intentionally left situ, those, (41.7%) had 26 (5.9%), performed. Termination performed 9 (2.0%), whom 5 fetal abnormalities. could be removed 90 (20.4%) at cesarean, 17 (3.9%) indicating mild no PAS. 34 (7.7%) an antenatal diagnosis PAS, spontaneously separated (false positives). We found lower .002) 2018-2019 compared 2009-2017, suggesting positive learning curve.In centers, most common severe followed by resection. Prenatal grade.