Materiały źródłowe

• #1 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #2 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Placenta accreta spectrum (PAS) disorders are considered to be iatrogenic conditions. They are more common in women with previous cesarean deliveries. The incidence and prevalence of PAS disorders continue to rise globally due to the increasing rate of cesarean deliveries. PAS disorders are associated with an increased risk of maternal morbidity and maternal mortality. This activity reviews the evaluation and management of women with PAS disorders and highlights the role of the interprofessional team in the care of patients with this condition. […] Therefore, these patients should be cared for by an interprofessional team. […] The American College of Obstetricians and Gynecologists (ACOG) has recommended delivery between 34 0/7 and 35 6/7 weeks of gestation via cesarean hysterectomy to optimize neonatal maturity and minimize the risk of maternal bleeding.

• #3 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. […] Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location. […] The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum.

• #4 Placenta Accreta | American Pregnancy Association

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/placenta-accreta/

  Placenta Accreta occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle and is the most common accounting for approximately 75% of all cases. […] The placenta usually has difficulty separating from the uterine wall. The primary concern for the mother is hemorrhaging during manual attempts to detach the placenta. Severe hemorrhaging can be life-threatening. Other concerns involve damage to the uterus or other organs (percreta) during removal of the placenta. Hysterectomy is a common therapeutic intervention, but the results involve the loss of the uterus and the ability to conceive. […] Upon diagnosis your healthcare provider will monitor your pregnancy with the intent of scheduling delivery and using a surgery that may spare the uterus. It is particularly important to discuss this surgery with your doctor if you desire to have additional children. Some cases may be severe enough that a hysterectomy may be needed. Again, it is important to discuss surgical options with your healthcare provider.

• #5 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. […] Placenta accreta is considered a high-risk pregnancy complication. If the condition is diagnosed during pregnancy, you’ll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy). […] Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery. The bleeding can cause a life-threatening condition that prevents your blood from clotting normally (disseminated intravascular coagulopathy), as well as lung failure (adult respiratory distress syndrome) and kidney failure. A blood transfusion will likely be necessary.

• #6 Placenta Accreta | Birth Injury Center

  https://birthinjurycenter.org/pregnancy-complications/placenta-accreta/

  Hemorrhaging after delivery is the most severe complication of placenta accreta. Vaginal bleeding may cause a condition called disseminated intravascular coagulopathy, which prevents the blood from clotting normally. […] Heavy bleeding may also cause lung failure or kidney failure in the mother, and women who experience this complication may require a blood transfusion after they give birth. […] Placenta accreta may also cause a woman to enter labor early and result in premature birth.

• #7 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #8 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  The incidence of placenta accreta has been increasing from 0.8/1000 in the 1980’s to 3/1000 deliveries. The risk increases with the increasing number of cesarean deliveries. […] The mainstay of antenatal diagnosis is ultrasound […] Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A) […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B)

• #9 Placenta accreta spectrum: Management – UpToDate

  https://www.uptodate.com/contents/placenta-accreta-spectrum-management

  For patients with placenta previa-accreta, prenatal care follows typical guidelines for management of placenta previa; however, the combination of PAS and placenta previa is associated with an increased risk of severe maternal and surgical morbidities compared with PAS alone. Management includes: Correction of iron deficiency anemia, if present.

• #10 Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study | Scientific Reports

  https://www.nature.com/articles/s41598-024-56964-9

  Maternal mortality and morbidity are lower in women with PAS disorders who deliver in a referral center with a multidisciplinary care team experienced in managing the surgical risks and perioperative challenges that these disorders present. […] The specific identification of risk factors for PAS in women with any prior cesareans and an abnormally located placenta may be useful for pinpointing women at particularly high risk of PAS to customize the information they receive as well as their care during pregnancy and delivery. […] This study suggests a pathophysiological hypothesis related to abnormal decidualization that should be investigated to find specific targets for preventing PAS disorders. […] Finally, the rate of PAS disorders varies greatly not only with the number of prior cesareans but also with the precise location of the placenta and some of the women’s individual characteristics. The specific identification of risk factors for PAS in women with any prior cesareans and a placenta previa or low lying will help to pinpoint women at particularly high risk of PAS to customize the information they receive as well as their care during pregnancy and delivery.

• #11 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #12 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  The incidence of placenta accreta has been increasing from 0.8/1000 in the 1980’s to 3/1000 deliveries. The risk increases with the increasing number of cesarean deliveries. […] The mainstay of antenatal diagnosis is ultrasound […] Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A) […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B)

• #13 Placenta Accreta: Causes, Symptoms, Treatment and Recovery

  https://www.webmd.com/baby/what-is-placenta-accreta

  Placenta accreta is usually diagnosed with an ultrasound. This can happen during a routine appointment. Your doctor may also specifically check for the condition if you fall into a high-risk category. In some cases, an MRI scan may be done to find out whether you have placenta accreta, increta, or percreta. […] The exact treatment for your condition will depend on how firmly your placenta is attached. You should plan on having your baby in a hospital. This will allow your medical team to provide any emergency medical treatment that you or your baby might need particularly emergency blood transfusions if you start to lose too much blood. […] Recovering from placenta accreta after delivery might be different from a standard delivery. If you had blood transfusions or a hysterectomy, you may need to stay in the intensive care unit (ICU) for a day or two to recover from extreme blood loss.

• #14 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  The incidence of placenta accreta has been increasing from 0.8/1000 in the 1980’s to 3/1000 deliveries. The risk increases with the increasing number of cesarean deliveries. […] The mainstay of antenatal diagnosis is ultrasound […] Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A) […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B)

• #15 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  The incidence of placenta accreta has been increasing from 0.8/1000 in the 1980’s to 3/1000 deliveries. The risk increases with the increasing number of cesarean deliveries. […] The mainstay of antenatal diagnosis is ultrasound […] Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A) […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B)

• #16 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  Placenta accreta occurs within a spectrum of disorders now referred to as ‘Placenta Accreta Spectrum’ (formerly ‘Morbidly Adherent Placenta’) […] It is advisable to refer women with clinical or ultrasound risk factors for placenta accreta to a center of excellence for evaluation, confirmation and delivery (Grade 1B – Strong recommendation – Moderate quality evidence) […] Optimal timing of delivery […] Administer corticosteroids to all women with suspected accreta if (SMFM recommendation Grade 1A) […] Outpatient: In the absence of bleeding and any other symptoms or complications, there is limited evidence that hospitalization is of benefit […] Inpatient: women with preterm labor, PPROM or bleeding are “most likely to benefit” from hospitalization […] Conservative management or expectant management should be considered only for carefully selected cases of Placenta Accreta Spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational (Grade 2C – Weak recommendation – Low quality evidence)

• #17 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. […] Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location. […] The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum.

• #18 Placenta Accreta Program at UTHealth Houston | UT Physicians

  https://www.utphysicians.com/placenta-accreta-program/

  Maternal-fetal medicine specialists provide expert care for high-risk pregnancy complications involving the placenta. […] The Placenta Accreta Program at UTHealth Houston offers a multidisciplinary team of board-certified specialists who help mothers with placenta accreta spectrum (PAS) disorder. Our experts provide a full spectrum of services, including prenatal testing, diagnostic imaging, and specialized maternal-fetal care. […] PAS disorder is an infrequent placental anomaly, usually diagnosed during the mid-trimester anatomy ultrasound at 18 to 22 weeks of pregnancy, but it may be discovered later, including at delivery. The quicker our team can diagnose the condition, the sooner we can minimize the risk of complications during delivery. […] Our medical team employs state-of-the-art imaging and sonar technology to precisely diagnose placenta accreta. We conduct routine imaging throughout pregnancy and post-delivery to optimize outcomes.

• #19 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. […] Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location. […] The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum.

• #20 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Before delivery, there should be a consideration for transfer to a Placenta Accreta Center of Excellence (PACE) or a level 3 or 4 center for delivery. […] Outcomes have been improved by delivery at these facilities due to the availability of a large, interprofessional team. […] The nurse plays a paramount role in the evaluation and management of women with PAS disorders. The nurse should monitor and update the clinician regarding vital signs and fetal cardiotocographs. The nurse should assist the obstetric provider in educating women with PAS disorders and their families about the nature of their condition and any anticipated challenges during their antenatal, natal, and postnatal periods. […] Patient education is key to the successful management of women with PAS disorders, and women should be provided with patient information leaflets that are easy to understand. […] Throughout these discussions and the patient’s antenatal and postpartum course, interprofessional team members should coordinate to optimize maternal and fetal outcomes.

• #21 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Delivery in highly experienced maternity centers that have this type of coordinated care team and the ability to garner additional expertise and resources in cases of severe hemorrhage appears to improve outcomes. […] Planned delivery at a center experienced with this condition is recommended whenever possible. Ideally, preoperative coordination with anesthesiology, maternalfetal medicine, neonatology, and expert pelvic surgeons can assist in proper preparations and allow the woman to ask questions, be counseled about the high likelihood and need for cesarean delivery or hysterectomy and potential complications, discuss anesthetic planning, and prepare for delivery. […] Given the extensive surgery, placenta accreta spectrum patients require intensive hemodynamic monitoring in the early postoperative period. This often is best provided in an intensive care unit setting to ensure hemodynamic and hemorrhagic stabilization.

• #22

  https://www.nursingcenter.com/journalarticle?Article_ID=5489513&Journal_ID=5188715&Issue_ID=5489512

  Placenta accreta spectrum (PAS) is a highly morbid and potentially fatal complication of pregnancy. […] As such, obstetrician gynecologists must be able to identify risk factors for PAS, be familiar with its associated morbidities, and implement strategies for PAS recognition, triage, and appropriate management to achieve optimal patient outcomes. […] Given the potential for morbidity and mortality associated with PAS, antenatal diagnosis of PAS is key in planning safe deliveries for women with this condition. […] Management of PAS by dedicated multidisciplinary teams is associated with lower composite scores of morbidity, lower incidence of massive transfusion, and fewer reoperations for bleeding complications. […] Emergent delivery and cesarean hysterectomy for patients with PAS are associated with increased blood loss and need for transfusion, higher volume of blood transfusion, and need for intensive care admission.

• #23 Placenta accreta spectrum: Management – UpToDate

  https://www.uptodate.com/contents/placenta-accreta-spectrum-management

  For patients with placenta previa-accreta, prenatal care follows typical guidelines for management of placenta previa; however, the combination of PAS and placenta previa is associated with an increased risk of severe maternal and surgical morbidities compared with PAS alone. Management includes: Correction of iron deficiency anemia, if present.

• #24 Management of patients with suspected placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8749385/

  It is critical to recognise the risk factors and identify patients with suspected placenta accreta spectrum (PAS); the most common risk factors for PAS are placenta praevia and previous Caesarean delivery. […] Women with risk factors for PAS should undergo imaging and diagnosis in the second or third trimester at centres with experience in the ultrasonographic diagnosis of PAS. […] Women with antenatally detectable risk factors for PAS, including placenta praevia, previous CS and uterine surgery and with suspected PAS, should undergo delivery at specialised maternal care centres with experience in managing PAS. […] An obstetric anaesthesia consultation should be provided to patients with suspected PAS before delivery. […] Patients with suspected PAS should be counselled about the likelihood for blood transfusion associated with their delivery.

• #25 October is Accreta Awareness Month | HealthFocus SA | University Health

  https://www.universityhealth.com/blog/accreta-whiteboard

  In cases where a placenta accreta is associated with a placenta previa, pelvic rest (no vaginal sex, nothing in vagina) is strongly recommended to avoid disruption of the placenta which could cause life-threatening bleeding. […] Evidence suggests that the best outcomes for women with placenta accreta is when the woman is delivered at a high level (level IV is the highest) maternal center that has an established team with experience in the evaluation, diagnosis, pre-operative planning and management. […] Our placenta accreta team at University Health has a comprehensive team of providers who specialize in the care for women with placenta accreta.

• #26 Placenta Accreta Spectrum Disorder Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/placenta-accreta

  Placenta accreta spectrum disorder (PAS) is a serious pregnancy condition in which the placenta grows too deeply into the wall of the uterus. […] If you have placenta accreta, you’ll work closely with your health care team for a safe pregnancy and delivery. To stop the bleeding, your doctor may need to do a C-section or remove the uterus (a hysterectomy) after birth. […] Placenta accreta is very dangerous for moms-to-be. It may cause life-threatening bleeding when you’re giving birth to your baby. […] If you have PAS, your doctor will help you design a birth plan that’s safe for you and your baby. There is no way to fix placenta accreta. Your doctor will help you make a plan to keep you and your baby as safe as possible. […] You may need to go on bed rest if you’re having vaginal bleeding.

• #27 Placenta accreta | Altru Health System

  https://www.altru.org/health-library/conditions/placenta-accreta

  Prepare for a hysterectomy. After the hysterectomy, you’ll no longer have menstrual cycles or be able to get pregnant. Ask your health care provider about what to expect during your recovery, the length of recovery and how the surgery might affect your recovery after giving birth. […] If you have vaginal bleeding during your third trimester, contact your health care provider right away. If the bleeding is severe, seek emergency care.

• #28 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Delivery in highly experienced maternity centers that have this type of coordinated care team and the ability to garner additional expertise and resources in cases of severe hemorrhage appears to improve outcomes. […] Planned delivery at a center experienced with this condition is recommended whenever possible. Ideally, preoperative coordination with anesthesiology, maternalfetal medicine, neonatology, and expert pelvic surgeons can assist in proper preparations and allow the woman to ask questions, be counseled about the high likelihood and need for cesarean delivery or hysterectomy and potential complications, discuss anesthetic planning, and prepare for delivery. […] Given the extensive surgery, placenta accreta spectrum patients require intensive hemodynamic monitoring in the early postoperative period. This often is best provided in an intensive care unit setting to ensure hemodynamic and hemorrhagic stabilization.

• #29 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #30 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Placenta accreta spectrum (PAS) disorders are considered to be iatrogenic conditions. They are more common in women with previous cesarean deliveries. The incidence and prevalence of PAS disorders continue to rise globally due to the increasing rate of cesarean deliveries. PAS disorders are associated with an increased risk of maternal morbidity and maternal mortality. This activity reviews the evaluation and management of women with PAS disorders and highlights the role of the interprofessional team in the care of patients with this condition. […] Therefore, these patients should be cared for by an interprofessional team. […] The American College of Obstetricians and Gynecologists (ACOG) has recommended delivery between 34 0/7 and 35 6/7 weeks of gestation via cesarean hysterectomy to optimize neonatal maturity and minimize the risk of maternal bleeding.

• #31 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Before delivery, there should be a consideration for transfer to a Placenta Accreta Center of Excellence (PACE) or a level 3 or 4 center for delivery. […] Outcomes have been improved by delivery at these facilities due to the availability of a large, interprofessional team. […] The nurse plays a paramount role in the evaluation and management of women with PAS disorders. The nurse should monitor and update the clinician regarding vital signs and fetal cardiotocographs. The nurse should assist the obstetric provider in educating women with PAS disorders and their families about the nature of their condition and any anticipated challenges during their antenatal, natal, and postnatal periods. […] Patient education is key to the successful management of women with PAS disorders, and women should be provided with patient information leaflets that are easy to understand. […] Throughout these discussions and the patient’s antenatal and postpartum course, interprofessional team members should coordinate to optimize maternal and fetal outcomes.

• #32 ACOG SMFM Obstetric Care Consensus #7: Placenta Accreta Spectrum – SMFM Publications and Clinical Guidelines

  https://publications.smfm.org/publications/266-acog-smfm-obstetric-care-consensus-7-placenta-accreta/

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus(attempts at placental removal are associated with significant risk of hemorrhage). Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. […] In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location.

• #33 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #34 Common Questions about Placenta Accreta Spectrum (PAS): | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/obgyn/accreta/QandA

  The Accreta Team will decide on the optimal timing of delivery and discuss this with the patient. […] If a woman has significant vaginal bleeding during the third trimester, recommendations for hospitalization or earlier delivery may happen. […] A combined spinal-epidural anesthesia is often used at the beginning of the surgery to allow the patient to be awake for the babys delivery. […] However, if long, complicated surgeries are required then general anesthesia may be necessary for safety and comfort either at the start of the surgery or after the baby is delivered. […] Most mothers are able to try to breastfeed, and our hospitals lactation specialists are available for consultation. […] Sometimes breast milk may take longer to come in after surgery, however women who desire to breastfeed are well supported.

• #35 Management of patients with suspected placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8749385/

  As haemorrhage is the leading cause of morbidity and mortality related to PAS CS with or without hysterectomy, a focus on haemorrhage resuscitation is essential. […] Patients with PAS require vigilant monitoring after surgery for ongoing bleeding, anaemia, fluid overload and multi-organ dysfunction. […] Admission to ICU after CS for PAS can be determined by the need for ongoing vasoactive infusions, tracheal intubation, high quantity of fluids and blood products given, anticipated need for additional transfusion and pulmonary oedema or coagulopathy. […] Women with suspected PAS should receive thorough antepartum counseling about their options for anaesthesia and the associated risks of PPH requiring transfusion, increased vascular access and potential need for general anaesthesia.

• #36 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  Planned delivery is preferred due to lower blood loss and complications than with emergent cesarean-hysterectomy. […] Preoperative planning should include checklists for scheduled and emergent scenarios, as well as administration of late preterm steroids for fetal lung maturation. […] A three-way Foley catheter may help with bladder distention and surgical dissection. […] Patient positioning in modified dorsal lithotomy with stirrups allows for vaginal bleeding quantification, placement of vaginal packing, and room for an additional surgical assistant. […] In patients desiring fertility, manual placental removal may be cautiously attempted after adequate counseling about its association with significant complications including large blood loss and high likelihood of failure requiring hysterectomy.

• #37 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. […] Your health care team will include your obstetrician and gynecologist, subspecialists in pelvic surgery, an anesthesia team, and a pediatric team. […] Your health care provider will discuss the risks and potential complications associated with placenta accreta. […] During your C-section, your health care provider will deliver your baby through an initial incision in your abdomen and a second incision in your uterus. […] After a hysterectomy, you no longer can become pregnant. […] If your health care provider suspects that you have placenta accreta, you’ll likely worry about how your condition will affect your delivery, your baby and, possibly, future pregnancies.

• #38 Placenta accreta | Altru Health System

  https://www.altru.org/health-library/conditions/placenta-accreta

  Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. […] Placenta accreta is considered a high-risk pregnancy complication. If the condition is diagnosed during pregnancy, you’ll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy). […] If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. […] In the case of extensive placenta accreta, a C-section followed by the surgical removal of the uterus (hysterectomy) might be necessary. This procedure, also called a cesarean hysterectomy, helps prevent the potentially life-threatening blood loss that can occur if there’s an attempt to separate the placenta.

• #39 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  Planned delivery is preferred due to lower blood loss and complications than with emergent cesarean-hysterectomy. […] Preoperative planning should include checklists for scheduled and emergent scenarios, as well as administration of late preterm steroids for fetal lung maturation. […] A three-way Foley catheter may help with bladder distention and surgical dissection. […] Patient positioning in modified dorsal lithotomy with stirrups allows for vaginal bleeding quantification, placement of vaginal packing, and room for an additional surgical assistant. […] In patients desiring fertility, manual placental removal may be cautiously attempted after adequate counseling about its association with significant complications including large blood loss and high likelihood of failure requiring hysterectomy.

• #40 Management of patients with suspected placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8749385/

  As haemorrhage is the leading cause of morbidity and mortality related to PAS CS with or without hysterectomy, a focus on haemorrhage resuscitation is essential. […] Patients with PAS require vigilant monitoring after surgery for ongoing bleeding, anaemia, fluid overload and multi-organ dysfunction. […] Admission to ICU after CS for PAS can be determined by the need for ongoing vasoactive infusions, tracheal intubation, high quantity of fluids and blood products given, anticipated need for additional transfusion and pulmonary oedema or coagulopathy. […] Women with suspected PAS should receive thorough antepartum counseling about their options for anaesthesia and the associated risks of PPH requiring transfusion, increased vascular access and potential need for general anaesthesia.

• #41 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  The multidisciplinary team and blood bank should be immediately alerted. […] Prompt replacement of blood products in the ratio of 1:1:1 to 1:2:4 of packed red blood cells: fresh frozen plasma: platelets is recommended. […] Intrauterine balloon tamponade and tranexamic acid may help minimize blood loss while necessary preparations are made. […] Hysterectomy is generally performed in the usual fashion. […] Conservative or expectant management of placenta previa should be rare and considered only in individual cases.

• #42 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  The multidisciplinary team and blood bank should be immediately alerted. […] Prompt replacement of blood products in the ratio of 1:1:1 to 1:2:4 of packed red blood cells: fresh frozen plasma: platelets is recommended. […] Intrauterine balloon tamponade and tranexamic acid may help minimize blood loss while necessary preparations are made. […] Hysterectomy is generally performed in the usual fashion. […] Conservative or expectant management of placenta previa should be rare and considered only in individual cases.

• #43 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  The multidisciplinary team and blood bank should be immediately alerted. […] Prompt replacement of blood products in the ratio of 1:1:1 to 1:2:4 of packed red blood cells: fresh frozen plasma: platelets is recommended. […] Intrauterine balloon tamponade and tranexamic acid may help minimize blood loss while necessary preparations are made. […] Hysterectomy is generally performed in the usual fashion. […] Conservative or expectant management of placenta previa should be rare and considered only in individual cases.

• #44 National Accreta Foundation — Placenta Accreta Patient & Family Resources | National Accreta Foundation

  https://www.preventaccreta.org/accreta-resources

  Read articles written by placenta accreta survivors and families on such topics as what to pack in your hospital bag, tips for bringing older siblings to visit mom in the hospital and suggested topics for pre-delivery discussion with your family and support network. […] 90% of placenta accreta mothers require blood transfusion, and 40% need more than 10 units of donor blood. Donate blood or host a blood drive to help ensure the next accreta mom has access to the blood products that may be needed for her care.

• #45

  https://www.nursingcenter.com/journalarticle?Article_ID=5489513&Journal_ID=5188715&Issue_ID=5489512

  As mentioned earlier, multidisciplinary teams dedicated to the care of patients with PAS have been shown to reduce maternal morbidity. […] Given that many patients with PAS are undiagnosed before their delivery, it is not always possible to mobilize a multidisciplinary team or plan for care of the patient in a tertiary setting. Thus, it is critical that all obstetricians be knowledgeable regarding the management of PAS. […] The standard of care for patients with PAS is peripartum hysterectomy. Alternate approaches should only be offered to selected patients after extensive counseling about the risks of conservative management, including possible need for eventual and perhaps emergent hysterectomy, delayed hemorrhage, need for additional surgical procedures (including uterine curettage and hysteroscopic resection of placenta), and possibility of significant morbidity related to conservative measures (eg, infection in expectant management). […] All women who undergo conservative management should be informed that likelihood of recurrent PAS in a future pregnancy is high.

• #46 Placenta Accreta Spectrum Disorder: Definitions and Management – The ObG Project

  https://www.obgproject.com/2017/03/16/placenta-accreta-optimal-time-deliver/

  Placenta accreta occurs within a spectrum of disorders now referred to as ‘Placenta Accreta Spectrum’ (formerly ‘Morbidly Adherent Placenta’) […] It is advisable to refer women with clinical or ultrasound risk factors for placenta accreta to a center of excellence for evaluation, confirmation and delivery (Grade 1B – Strong recommendation – Moderate quality evidence) […] Optimal timing of delivery […] Administer corticosteroids to all women with suspected accreta if (SMFM recommendation Grade 1A) […] Outpatient: In the absence of bleeding and any other symptoms or complications, there is limited evidence that hospitalization is of benefit […] Inpatient: women with preterm labor, PPROM or bleeding are “most likely to benefit” from hospitalization […] Conservative management or expectant management should be considered only for carefully selected cases of Placenta Accreta Spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational (Grade 2C – Weak recommendation – Low quality evidence)

• #47

  https://journals.lww.com/md-journal/fulltext/2017/03100/management_of_patients_with_placenta_accreta_in.52.aspx

  A multidisciplinary integrated management strategy at an appropriate tertiary care center is essential, in order to reduce the mortality and morbidity associated with placenta accrete. […] The treatment modalities of conservative approach include use of methotrexate, uterine artery embolization, dilation and curettage, and hysteroscopic loop resection. […] The purpose of this retrospective study is to analyze the clinical characteristics, management strategies, and outcomes in 21 patients with placenta accreta and having concomitant fever in the peripartum period. […] Management during the peripartum and postpartum periods is summarized in Table 3. […] Postpartum management of retained placenta accreta includes treatment with methotrexate and mifepristone, uterine artery embolization, dilation and curettage, and delayed hysterectomy. […] We recommend performing curettage under ultrasound guidance so as to avoid inversion or perforation of the uterus. […] We hope that our experience and management strategy provides valuable guidance for the treatment of placenta accreta, diagnosed in the peripartum period.

• #48 National Accreta Foundation — What Do Accreta Patients Need to Know? | Placenta Accreta Patient FAQ | National Accreta Foundation

  https://www.preventaccreta.org/faq

  The ACOG SMFM Accreta Care Consensus states: Conservative management or expectant management should be considered only for carefully selected cases of placenta accreta spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational. If you are going down this path, do know that current literature DOES NOT recommend use of methotrexate for placental reabsorption due to the possibility of maternal harm.

• #49 Study on Outcomes of Pregnancy in Women with Placenta Accreta Spectrum: A 10-year Study in a Tertiary Care Center

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/25042/JPJ/fullText

  Placenta accreta spectrum (PAS) disorders include accreta, increta, and percreta, which are associated with increased maternal morbidity and mortality. […] Conservative management by leaving the placenta in situ with arterial embolization helps women to retain the uterus and reduces maternal morbidity in PAS disorders. […] For women who wish to retain uterus and to minimize obstetric hemorrhage, other options such as placenta left in situ with uterine artery embolization (UAE) are the alternative strategies. […] The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine recommend all women diagnosed with PAS disorder should receive level III (subspecialty) or higher care. […] The follow-up of women in whom the placenta was left in situ can be done by history, pelvic examination, and ultrasonography of placental mass. The residual placenta tissue may require from 6 months to 1 year for complete resolution.

• #50 Placenta Accreta Program at UTHealth Houston | UT Physicians

  https://www.utphysicians.com/placenta-accreta-program/

  Three options for treatment offered at UTHealth Houston are C-section and hysterectomy, delayed hysterectomy, or keeping the uterus for a potential future pregnancy. You will be counseled on the risks and benefits of each approach. […] According to the American College of Obstetricians and Gynecologists, the generally accepted approach to placenta accreta spectrum is a cesarean hysterectomy with the placenta left in place after delivery. Attempts at placenta removal are associated with a significant risk of hemorrhage. […] If the placenta invades the bladder or surrounding tissues, delaying the hysterectomy allows time for the accreta to shrink, lessening the risk of potential injury to other organs, bleeding, and admission to the intensive care unit. […] We counsel them extensively about the importance of follow-up. We continue to monitor them after delivery for signs of infection or bleeding, which are risk factors, while the placenta shrinks and reabsorbs. With our expert team and streamlined process, we can act quickly if there is any reason for concern. This is an important option for women who want to keep their uterus for a potential future pregnancy, or for cultural or religious reasons. We always advise that we may need to do a hysterectomy, depending on what happens during the delivery.

• #51 Placenta Accreta | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/placenta-accreta

  Your hysterectomy may take place four to six weeks after your childs birth if your placenta accreta is severe and the placenta attaches to other organs, such as your bladder. During your cesarean section, your doctor will leave some or all of the placenta in place to be removed later during your delayed hysterectomy.

• #52 Management of Placenta Accreta at Delivery

  https://exxcellence.org/list-of-pearls/management-of-placenta-accreta-at-delivery/

  Planned delivery is preferred due to lower blood loss and complications than with emergent cesarean-hysterectomy. […] Preoperative planning should include checklists for scheduled and emergent scenarios, as well as administration of late preterm steroids for fetal lung maturation. […] A three-way Foley catheter may help with bladder distention and surgical dissection. […] Patient positioning in modified dorsal lithotomy with stirrups allows for vaginal bleeding quantification, placement of vaginal packing, and room for an additional surgical assistant. […] In patients desiring fertility, manual placental removal may be cautiously attempted after adequate counseling about its association with significant complications including large blood loss and high likelihood of failure requiring hysterectomy.

• #53 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient?TRILIBIS_EMULATOR_UA=…%2C

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients who preserve their uterus in the face of accreta should be counseled carefully prior to experiencing another pregnancy.

• #54

  https://www.nursingcenter.com/journalarticle?Article_ID=5489513&Journal_ID=5188715&Issue_ID=5489512

  As mentioned earlier, multidisciplinary teams dedicated to the care of patients with PAS have been shown to reduce maternal morbidity. […] Given that many patients with PAS are undiagnosed before their delivery, it is not always possible to mobilize a multidisciplinary team or plan for care of the patient in a tertiary setting. Thus, it is critical that all obstetricians be knowledgeable regarding the management of PAS. […] The standard of care for patients with PAS is peripartum hysterectomy. Alternate approaches should only be offered to selected patients after extensive counseling about the risks of conservative management, including possible need for eventual and perhaps emergent hysterectomy, delayed hemorrhage, need for additional surgical procedures (including uterine curettage and hysteroscopic resection of placenta), and possibility of significant morbidity related to conservative measures (eg, infection in expectant management). […] All women who undergo conservative management should be informed that likelihood of recurrent PAS in a future pregnancy is high.

• #55 Caring for the Placenta Accreta Patient – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/caring-for-the-placenta-accreta-patient

  Caring for the Placenta Accreta Patient Topics Frequency According to the Society of Maternal-Fetal Medicine, the frequency of placenta accreta has increased from 0.8 per 1,000 deliveries in the 1980s to 3 per 1,000 deliveries in the past decade. The primary risks for placenta accreta are prior cesarean deliveries and the presence of placenta previa. Understanding these patients risk factors and clinical presentations is essential for patient counseling and a safe delivery. All patients with risk factors should be evaluated carefully for accreta during pregnancy. An antepartum diagnosis is important because it allows for multidisciplinary delivery planning and detailed patient counseling. Delivery should be planned on a unit with 24-hour access to full blood bank services and a massive transfusion protocol. Patients with accreta may be managed with neuraxial anesthesia (epidural with or without a spinal anesthetic), general anesthesia, or a combination of both. After a complicated delivery, accreta patients are at risk for persistent coagulopathy and anemia, thromboembolism, and renal, cardiac and other organ dysfunction. Patients require close monitoring, sometimes in an intensive care setting.

• #56 Management of patients with suspected placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8749385/

  As haemorrhage is the leading cause of morbidity and mortality related to PAS CS with or without hysterectomy, a focus on haemorrhage resuscitation is essential. […] Patients with PAS require vigilant monitoring after surgery for ongoing bleeding, anaemia, fluid overload and multi-organ dysfunction. […] Admission to ICU after CS for PAS can be determined by the need for ongoing vasoactive infusions, tracheal intubation, high quantity of fluids and blood products given, anticipated need for additional transfusion and pulmonary oedema or coagulopathy. […] Women with suspected PAS should receive thorough antepartum counseling about their options for anaesthesia and the associated risks of PPH requiring transfusion, increased vascular access and potential need for general anaesthesia.

• #57 Management of patients with suspected placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8749385/

  As haemorrhage is the leading cause of morbidity and mortality related to PAS CS with or without hysterectomy, a focus on haemorrhage resuscitation is essential. […] Patients with PAS require vigilant monitoring after surgery for ongoing bleeding, anaemia, fluid overload and multi-organ dysfunction. […] Admission to ICU after CS for PAS can be determined by the need for ongoing vasoactive infusions, tracheal intubation, high quantity of fluids and blood products given, anticipated need for additional transfusion and pulmonary oedema or coagulopathy. […] Women with suspected PAS should receive thorough antepartum counseling about their options for anaesthesia and the associated risks of PPH requiring transfusion, increased vascular access and potential need for general anaesthesia.

• #58 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Delivery in highly experienced maternity centers that have this type of coordinated care team and the ability to garner additional expertise and resources in cases of severe hemorrhage appears to improve outcomes. […] Planned delivery at a center experienced with this condition is recommended whenever possible. Ideally, preoperative coordination with anesthesiology, maternalfetal medicine, neonatology, and expert pelvic surgeons can assist in proper preparations and allow the woman to ask questions, be counseled about the high likelihood and need for cesarean delivery or hysterectomy and potential complications, discuss anesthetic planning, and prepare for delivery. […] Given the extensive surgery, placenta accreta spectrum patients require intensive hemodynamic monitoring in the early postoperative period. This often is best provided in an intensive care unit setting to ensure hemodynamic and hemorrhagic stabilization.

• #59 Placenta Accreta | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/placenta-accreta

  We prepare for any complications in delivery by involving our obstetric anesthesiologists, fetal diagnosticians, and blood transfusion specialists leading up to your delivery. Your care team will also include interventional radiologists, perinatologists (high-risk pregnancy doctors), and neonatologists. […] Blood thinning medication may be needed for up to one month after delivery to prevent clotting. You’ll have at least two postpartum visits with your doctor to make sure your body is healing. The first will take place about a week after you’re discharged from the hospital, and the second will be four to six weeks later. Along with your physical health, we’ll make sure your transition to having a new baby at home is going well and offer any advice you may need. […] Because the placenta cant be easily separated from the uterus, performing a hysterectomy during a birth with placenta accreta is required to control blood loss and keep you safe. Almost all hysterectomies with placenta accreta take place right after delivery. Severe cases may require a delayed hysterectomy several weeks later. In either case, you will remain in the hospital for several days. Total recovery takes about eight weeks.

• #60 Placenta Accreta | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/placenta-accreta

  We prepare for any complications in delivery by involving our obstetric anesthesiologists, fetal diagnosticians, and blood transfusion specialists leading up to your delivery. Your care team will also include interventional radiologists, perinatologists (high-risk pregnancy doctors), and neonatologists. […] Blood thinning medication may be needed for up to one month after delivery to prevent clotting. You’ll have at least two postpartum visits with your doctor to make sure your body is healing. The first will take place about a week after you’re discharged from the hospital, and the second will be four to six weeks later. Along with your physical health, we’ll make sure your transition to having a new baby at home is going well and offer any advice you may need. […] Because the placenta cant be easily separated from the uterus, performing a hysterectomy during a birth with placenta accreta is required to control blood loss and keep you safe. Almost all hysterectomies with placenta accreta take place right after delivery. Severe cases may require a delayed hysterectomy several weeks later. In either case, you will remain in the hospital for several days. Total recovery takes about eight weeks.

• #61 Study on Outcomes of Pregnancy in Women with Placenta Accreta Spectrum: A 10-year Study in a Tertiary Care Center

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/25042/JPJ/fullText

  Placenta accreta spectrum (PAS) disorders include accreta, increta, and percreta, which are associated with increased maternal morbidity and mortality. […] Conservative management by leaving the placenta in situ with arterial embolization helps women to retain the uterus and reduces maternal morbidity in PAS disorders. […] For women who wish to retain uterus and to minimize obstetric hemorrhage, other options such as placenta left in situ with uterine artery embolization (UAE) are the alternative strategies. […] The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine recommend all women diagnosed with PAS disorder should receive level III (subspecialty) or higher care. […] The follow-up of women in whom the placenta was left in situ can be done by history, pelvic examination, and ultrasonography of placental mass. The residual placenta tissue may require from 6 months to 1 year for complete resolution.

• #62 Placenta Accreta: Symptoms, Risk Factors, & Treatment | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/placenta-accreta

  Our clinic includes the expertise of social workers and psychologists. They offer you offer mental health counseling and support. We discuss the risks of medical trauma and post-traumatic stress at your diagnosis. […] We have several specialists available on your delivery day. Experts in these areas help ensure you have a healthy birth: […] A placenta accreta diagnosis can have significant psychological effects. People with the condition often feel worried throughout their pregnancy. Its common to experience anxiety, depression, or post-traumatic stress after your delivery. […] Losing your fertility may cause grief and other challenging emotions.

• #63 Placenta Accreta: Symptoms, Risk Factors, & Treatment | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/placenta-accreta

  Our clinic includes the expertise of social workers and psychologists. They offer you offer mental health counseling and support. We discuss the risks of medical trauma and post-traumatic stress at your diagnosis. […] We have several specialists available on your delivery day. Experts in these areas help ensure you have a healthy birth: […] A placenta accreta diagnosis can have significant psychological effects. People with the condition often feel worried throughout their pregnancy. Its common to experience anxiety, depression, or post-traumatic stress after your delivery. […] Losing your fertility may cause grief and other challenging emotions.

• #64 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  To ease your anxiety: Find out about placenta accreta. Gathering information about your condition might help you feel less anxious. […] Prepare for a C-section. Ask questions about the procedure, pain management and expectations for recovery. […] Prepare for a hysterectomy. After the hysterectomy, you’ll no longer have menstrual cycles or be able to get pregnant. […] Some questions to ask your health care provider about placenta accreta include: What treatment approach do you recommend? […] Will I need a hysterectomy after the baby is delivered?

• #65 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Before delivery, there should be a consideration for transfer to a Placenta Accreta Center of Excellence (PACE) or a level 3 or 4 center for delivery. […] Outcomes have been improved by delivery at these facilities due to the availability of a large, interprofessional team. […] The nurse plays a paramount role in the evaluation and management of women with PAS disorders. The nurse should monitor and update the clinician regarding vital signs and fetal cardiotocographs. The nurse should assist the obstetric provider in educating women with PAS disorders and their families about the nature of their condition and any anticipated challenges during their antenatal, natal, and postnatal periods. […] Patient education is key to the successful management of women with PAS disorders, and women should be provided with patient information leaflets that are easy to understand. […] Throughout these discussions and the patient’s antenatal and postpartum course, interprofessional team members should coordinate to optimize maternal and fetal outcomes.

• #66 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Before delivery, there should be a consideration for transfer to a Placenta Accreta Center of Excellence (PACE) or a level 3 or 4 center for delivery. […] Outcomes have been improved by delivery at these facilities due to the availability of a large, interprofessional team. […] The nurse plays a paramount role in the evaluation and management of women with PAS disorders. The nurse should monitor and update the clinician regarding vital signs and fetal cardiotocographs. The nurse should assist the obstetric provider in educating women with PAS disorders and their families about the nature of their condition and any anticipated challenges during their antenatal, natal, and postnatal periods. […] Patient education is key to the successful management of women with PAS disorders, and women should be provided with patient information leaflets that are easy to understand. […] Throughout these discussions and the patient’s antenatal and postpartum course, interprofessional team members should coordinate to optimize maternal and fetal outcomes.

• #67 Placenta Accreta Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/placenta-accreta/

  Placenta accreta is an uncommon condition in which the chorionic villa adheres to the myometrium. […] Associated findings. Placenta accrete is usually diagnosed in the immediate post partum period when the placenta fails to separate. […] Identify placenta accreta in the client. Be aware of the clients risk status. […] Assist with rapid treatment and intervention. Be prepared for a DC or hysterectomy. […] Provide physical and emotional support. […] Provide client and family education.

• #68 ACOG SMFM Obstetric Care Consensus #7: Placenta Accreta Spectrum – SMFM Publications and Clinical Guidelines

  https://publications.smfm.org/publications/266-acog-smfm-obstetric-care-consensus-7-placenta-accreta/

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus(attempts at placental removal are associated with significant risk of hemorrhage). Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. […] In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location.

• #69 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Before delivery, there should be a consideration for transfer to a Placenta Accreta Center of Excellence (PACE) or a level 3 or 4 center for delivery. […] Outcomes have been improved by delivery at these facilities due to the availability of a large, interprofessional team. […] The nurse plays a paramount role in the evaluation and management of women with PAS disorders. The nurse should monitor and update the clinician regarding vital signs and fetal cardiotocographs. The nurse should assist the obstetric provider in educating women with PAS disorders and their families about the nature of their condition and any anticipated challenges during their antenatal, natal, and postnatal periods. […] Patient education is key to the successful management of women with PAS disorders, and women should be provided with patient information leaflets that are easy to understand. […] Throughout these discussions and the patient’s antenatal and postpartum course, interprofessional team members should coordinate to optimize maternal and fetal outcomes.

• #70 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  To ease your anxiety: Find out about placenta accreta. Gathering information about your condition might help you feel less anxious. […] Prepare for a C-section. Ask questions about the procedure, pain management and expectations for recovery. […] Prepare for a hysterectomy. After the hysterectomy, you’ll no longer have menstrual cycles or be able to get pregnant. […] Some questions to ask your health care provider about placenta accreta include: What treatment approach do you recommend? […] Will I need a hysterectomy after the baby is delivered?

• #71 National Accreta Foundation — How to Choose a Hospital for your Placenta Accreta Delivery | Placenta Accreta Center of Excellence

  https://www.preventaccreta.org/hospital

  There is the potential need for accreta moms to require admission to an intensive care unit after surgery, so it’s essential that the hospital is equipped to ensure they are ready in case critical care is needed. […] As a result of preterm delivery, many accreta babies require admission to a neonatal intensive care unit. Look for a hospital that has access to a level III or IV NICU for life-saving interventions, should your baby need it. […] After doing your research and gathering opinions from a provider or more, listen to your intuition. If you’re not feeling right about your care, keep looking. Find a provider you feel comfortable with, who will support you and ensure you get the very best care. […] ACOG recommends women with suspected placenta accreta spectrum diagnosed in the antenatal period based on imaging or clinical acumen should be delivered at a level III or IV center with considerable experience whenever possible to improve outcomes. […] Both efforts have helped pave the way for improvements in caring for accreta moms, and more will be done over the coming years.

• #72 Placenta Accreta | CHRISTUS Health

  https://www.christushealth.org/get-care/services-specialties/womens-services/labor-and-delivery/maternal-fetal-care/placenta-accreta

• #73 National Accreta Foundation — How to Choose a Hospital for your Placenta Accreta Delivery | Placenta Accreta Center of Excellence

  https://www.preventaccreta.org/hospital

  When it comes to a life-threatening, high-risk pregnancy condition like placenta accreta spectrum, the quality of care received matters greatly. It requires specialized maternity and neonatal care, along with established accreta teams who do volume of these deliveries. […] Doctors and specialists with experience in the care of placenta accreta and appropriate surgical expertise is critical. Some hospitals have developed specific placental disorder programs and teams to help manage the increased number of patients. […] Accreta moms have an increased risk for hemorrhage and surgical complications, and an accreta surgery can be best managed by specialists and a multidisciplinary team. […] Accreta moms are at risk for massive hemorrhage and there’s a high chance (up to 90%) that a blood transfusion will be required, often in large quantities.

• #74 Comprehensive Placenta Accreta Care Program Achieves Superior Outcomes  | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/comprehensive-placenta-accreta-care-program-achieves-superior-outcomes

  Current data suggests that the incidence of severe maternal morbidity of patients with PAS is higher than other serious conditions in pregnancy, such as pulmonary hypertension. We can lower morbidity rates if we identify risk factors and plan for a safe delivery, says Gilner. […] Dukes Placenta Accreta Care Program achieves lower severe maternal morbidity rates compared to national averages, including blood loss and likelihood of transfusion. […] Considering that 30 to 40% of patients with accreta require urgent or unscheduled delivery prior to their intended delivery date, its important for care teams to have standardized systems and mobilize quickly. Our specialists are available 24/7, says Gilner. […] After a consultative ultrasound, Gilners team stratifies patients by level of risk to provide the most clinically appropriate recommendations. Traveling to our center for delivery may be hard for some patients, so we only make that recommendation if the risk of needing a specialized surgical team is high. Patients with lower risks can often deliver with their local obstetrician. We can collaborate with them to develop a safe delivery plan, says Gilner.

• #75 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  Delivery in highly experienced maternity centers that have this type of coordinated care team and the ability to garner additional expertise and resources in cases of severe hemorrhage appears to improve outcomes. […] Planned delivery at a center experienced with this condition is recommended whenever possible. Ideally, preoperative coordination with anesthesiology, maternalfetal medicine, neonatology, and expert pelvic surgeons can assist in proper preparations and allow the woman to ask questions, be counseled about the high likelihood and need for cesarean delivery or hysterectomy and potential complications, discuss anesthetic planning, and prepare for delivery. […] Given the extensive surgery, placenta accreta spectrum patients require intensive hemodynamic monitoring in the early postoperative period. This often is best provided in an intensive care unit setting to ensure hemodynamic and hemorrhagic stabilization.

• #76 Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study | Scientific Reports

  https://www.nature.com/articles/s41598-024-56964-9

  Maternal mortality and morbidity are lower in women with PAS disorders who deliver in a referral center with a multidisciplinary care team experienced in managing the surgical risks and perioperative challenges that these disorders present. […] The specific identification of risk factors for PAS in women with any prior cesareans and an abnormally located placenta may be useful for pinpointing women at particularly high risk of PAS to customize the information they receive as well as their care during pregnancy and delivery. […] This study suggests a pathophysiological hypothesis related to abnormal decidualization that should be investigated to find specific targets for preventing PAS disorders. […] Finally, the rate of PAS disorders varies greatly not only with the number of prior cesareans but also with the precise location of the placenta and some of the women’s individual characteristics. The specific identification of risk factors for PAS in women with any prior cesareans and a placenta previa or low lying will help to pinpoint women at particularly high risk of PAS to customize the information they receive as well as their care during pregnancy and delivery.

• #77 Comprehensive Placenta Accreta Care Program Achieves Superior Outcomes  | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/comprehensive-placenta-accreta-care-program-achieves-superior-outcomes

  Current data suggests that the incidence of severe maternal morbidity of patients with PAS is higher than other serious conditions in pregnancy, such as pulmonary hypertension. We can lower morbidity rates if we identify risk factors and plan for a safe delivery, says Gilner. […] Dukes Placenta Accreta Care Program achieves lower severe maternal morbidity rates compared to national averages, including blood loss and likelihood of transfusion. […] Considering that 30 to 40% of patients with accreta require urgent or unscheduled delivery prior to their intended delivery date, its important for care teams to have standardized systems and mobilize quickly. Our specialists are available 24/7, says Gilner. […] After a consultative ultrasound, Gilners team stratifies patients by level of risk to provide the most clinically appropriate recommendations. Traveling to our center for delivery may be hard for some patients, so we only make that recommendation if the risk of needing a specialized surgical team is high. Patients with lower risks can often deliver with their local obstetrician. We can collaborate with them to develop a safe delivery plan, says Gilner.

• #78 Placenta Accreta: Causes, Symptoms and TreatmentCircleBumpCheckedFilledMedicalBookmarkBookmarkTickBookmarkAddCheckBoxCheckBoxFilled

  https://www.thebump.com/a/placenta-accreta

  Placenta accreta is a serious complication in pregnancy, but a diagnosis and plan can help improve the outcome for Mom and baby. […] While it’s true that placenta accreta is a very serious pregnancy complication, planning ahead and receiving proactive care can help improve the outcome for you and baby. […] If you have placenta accreta, you and your doctor will want to have a plan of action. That starts with information and education. […] The biggest risk for women is severe bleeding, which happens when part or all of the placenta stays attached to the uterine wall after delivery. […] If you are diagnosed with placenta accreta during pregnancy, your ob-gyn will most likely plan for an early c-section to help reduce the risk of hemorrhaging during delivery. […] When properly managed, the placenta accreta survival rate is high: between 96 and 99 percent, according to a recent review published in Clinical Obstetrics & Gynecology.

• #79 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. […] Your health care team will include your obstetrician and gynecologist, subspecialists in pelvic surgery, an anesthesia team, and a pediatric team. […] Your health care provider will discuss the risks and potential complications associated with placenta accreta. […] During your C-section, your health care provider will deliver your baby through an initial incision in your abdomen and a second incision in your uterus. […] After a hysterectomy, you no longer can become pregnant. […] If your health care provider suspects that you have placenta accreta, you’ll likely worry about how your condition will affect your delivery, your baby and, possibly, future pregnancies.

• #80

  https://www.nursingcenter.com/journalarticle?Article_ID=5489513&Journal_ID=5188715&Issue_ID=5489512

  As mentioned earlier, multidisciplinary teams dedicated to the care of patients with PAS have been shown to reduce maternal morbidity. […] Given that many patients with PAS are undiagnosed before their delivery, it is not always possible to mobilize a multidisciplinary team or plan for care of the patient in a tertiary setting. Thus, it is critical that all obstetricians be knowledgeable regarding the management of PAS. […] The standard of care for patients with PAS is peripartum hysterectomy. Alternate approaches should only be offered to selected patients after extensive counseling about the risks of conservative management, including possible need for eventual and perhaps emergent hysterectomy, delayed hemorrhage, need for additional surgical procedures (including uterine curettage and hysteroscopic resection of placenta), and possibility of significant morbidity related to conservative measures (eg, infection in expectant management). […] All women who undergo conservative management should be informed that likelihood of recurrent PAS in a future pregnancy is high.

Zobacz więcej