Materiały źródłowe

• #1 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. […] 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.

• #2 National Accreta Foundation — What is Placenta Accreta Spectrum?

  https://www.preventaccreta.org/accreta

  Placenta accreta, also known as placenta accreta spectrum (PAS), is a pregnancy complication that occurs when the placenta attaches too deeply into the wall of the uterus. […] It is imperative that women at risk of developing accreta receive prenatal care at facilities with expertise in diagnosing and treating the condition. […] While placenta accreta is not preventable as of now, National Accreta Foundation actively promotes efforts to decrease the amount of women at risk of developing accreta by increasing awareness of the condition, promoting appropriate use of cesareans, and improving quality of care for those who do develop PAS. […] National Accreta Foundation is also following multiple exciting research initiatives to understand why accreta occurs with hopes of detecting the condition early in pregnancy and potentially preventing it in the future.

• #3

  https://journals.lww.com/mfm/fulltext/2019/10000/how_to_reduce_the_incidence_of_placenta_accreta.2.aspx

  Placenta accreta spectrum (PAS) is growing worldwide, reaching epidemic proportions in many countries. […] Although new, complete, and updated guides tried to cover all aspects in relation with the PAS, none of them has proposed a practical solution to stop this frightening disease. […] It is possible, that was happened with the episiotomy, many years ago, that we need to rethink in older recommendations and to learn about the new insights about uterine healing to definitively cut off the cesarean-PAS high-risk morbid association.

• #4

  https://journalonsurgery.org/articles/js-v3-1119.html

  Placenta accreta spectrum (PAS) refers to the abnormal invasion of placental villi into the base of the decidua. […] The incidence of this disease has increased tenfold in the past 50 years, mainly considered as the result of the increase of cesarean sections and advanced maternal age, and was expected to keep on increasing over time. […] Cesarean sections and placenta previa are important obstetric factors leading to PAS. […] For gravidas with history of cesarean section, the risk of PAS is significantly higher than that without, and the incidence of PAS increases with the number of cesarean sections. […] When accompanied by placenta previa, the occurrence of PAS is markedly increased. […] In addition, gynecological operations such as curettage, myomectomy and hysteroscopy will also cause an increase in the incidence of PAS.

• #5 Management of placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10183858/

  Reducing caesarean section rates is the main preventive measure for the placenta accreta spectrum (PAS). […] In order to minimize its incidence, some authors have also recommended a high transverse hysterotomy in the first cesarean section, performed above the uterine segment. […] When available, advance diagnosis, adequate planning of surgical intervention and the use of effective techniques for intraoperative hemorrhagic control offer a greater possibility of preserving life, the uterus and fertility. […] All pregnant women with previous uterine surgery and low implantation placenta should undergo ultrasound evaluation at between 18 and 24 weeks of pregnancy. […] Delivery of stable patients with PAS should occur between 34 + 0 and 35 + 6 weeks. Antenatal use of corticosteroids is recommended. Interruptions even earlier than that are appropriate only if there are obstetric indications.

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

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

  There isn’t a way to prevent PAS. But you can significantly reduce your risk by only having a C-section if it’s medically necessary; this will reduce scarring in your uterus. […] Make sure you tell your ob-gyn about your surgical history. If the doctor thinks you’re at risk, they can do an ultrasound early to check your placenta.

• #7 National Accreta Foundation — Minimize the Risks of Placenta Accreta at Your Hospital | National Accreta Foundation

  https://www.preventaccreta.org/risk

  Decisions made regarding cesarean birth in a woman’s first pregnancy will likely affect the rest of her reproductive life. For this reason, both ACOG and Society for Maternal Fetal Medicine (SMFM) recommend safe reduction of primary cesarean utilization. […] Additionally, for patients with history of prior cesarean, ACOG recently announced that it no longer recommends that a physician be „immediately available” for TOLAC, and that candidates can undergo TOLAC in any hospital that provides access to emergency cesarean sections. […] Both ACOG and SMFM, along with 20 other professional organizations and patient advocates, comprise the Council on Patient Safety in Women’s Health Care. The implementation arm of the Council, Alliance for Innovation on Maternal Health (AIM), provides implementation support and data tracking for patient safety bundles.

• #8 National Accreta Foundation — Minimize the Risks of Placenta Accreta at Your Hospital | National Accreta Foundation

  https://www.preventaccreta.org/risk

  Patients: Please visit National Accreta Foundations Patient Family Resources page for a patient facing FAQ based on the latest literature and evidence based care recommendations for women with placenta accreta. […] Providers: Please visit National Accreta Foundations Professional Resources page for the latest in professional society publications related to placenta accreta. […] Early diagnosis of abnormal placentation and established protocols for transfer to a tertiary care center minimize potential risk by allowing for multidisciplinary planning for delivery at a risk-appropriate facility. […] In addition to patient counseling prior to and during their childbearing years on maintaining a healthy lifestyle, including smoking cessation and weight management, as well as family planning and pregnancy spacing, there are practice modifications and patient safety bundles that will minimize risk of maternal and neonatal morbidity and mortality from placenta accreta.

• #9 Placental Accreta, Increta and Percreta | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placental-accreta-increta-and-percreta

  Sometimes the placenta attaches itself into the wall of the uterus too deeply and doesnt go out after giving birth (delivery of the placenta). This can cause problems, including: […] When these conditions are found before birth, your provider may recommend a Cesarean section (also called c-section) immediately followed by a hysterectomy. This can help prevent bleeding from becoming life threatening. […] If you have a placental condition, the best time for you to have your baby is unknown. But your provider may recommend that you give birth at around 34 to 38 weeks of pregnancy to help prevent dangerous bleeding. […] One way to reduce your chances for having these kinds of placental conditions in future pregnancies is to have your babies by vaginal birth instead of c-section, if possible. Have a c-section only if there are health problems with you or your baby that make it medically necessary. […] If your pregnancy is healthy, its best to stay pregnant until labor begins on its own. Dont schedule a c-section for non-medical reasons, like wanting to have your baby on a certain day or because youre uncomfortable and want to have your baby earlier than your due date.

• #10 Comprehensive Management of Placenta Accreta – Obstetrics and Gynecology | NewYork-Presbyterian Advances

  https://www.nyp.org/newsletters/prof-adv/gynecology/comprehensive-management-of-placenta-accreta

  As the rate of Cesarean section deliveries increases in the United States, so, too, does the incidence of placenta accreta. […] The risk for developing a placenta accreta spectrum increases with each Cesarean section or uterine surgery; other risk factors include placenta previa, advanced maternal age, multiparity, and uterine curettage. […] The best way to manage this clinical condition is to know before the delivery that this condition is present and be prepared for it. […] We try to prevent the bleeding by not delivering the placenta, he says. We deliver the baby only and then we remove the whole uterus with the placenta left in place. […] We have that added level of protection to identify the anatomy in this area and to reduce the risk for urologic injury, says Dr. Moroz. […] We rely greatly on Dr. Catherine Monk, a clinical psychologist, and her mental health program within our department to provide services that include support groups and counseling to talk through some of the adjustment reaction that happens following a diagnosis like this.

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

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

  October is Placenta Accreta Awareness Month. […] Early recognition and delivery planning is critical for women with this pregnancy complication to prevent serious harm to mother and baby. […] The only potential way to prevent placenta accreta is to avoid having the initial cesarean delivery or uterine surgery as these are the strongest risk factors. There are no other interventions known at this time to prevent placenta accreta. […] Yes. If you are suspected or known to have a placenta accreta, delivery between 34- and 36-weeks gestation is recommended. This is to avoid going into labor, which could result in serious, 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.

• #12 Creating a treatment plan for placenta accreta during pregnancy – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/womens-health-articles/2019/october/creating-a-treatment-plan-for-placenta-accreta-during-pregnancy

  Calhouns care was transferred to the maternal-fetal medicine team. With our experts, she now had access to the Family Birth Center, where our multidisciplinary team was poised to offer comprehensive care. Placenta accretas require a highly specialized and coordinated effort to maximize safety during and after delivery. […] Its very important to coordinate delivery when the patient has an accreta to prevent the patient from experiencing life-threatening blood loss, which can occur if the patient suddenly goes into labor. A treatment plan is also helpful because it allows the patient the opportunity to understand the effects of a hysterectomy and ask any questions that may arise. […] If a patient does not want to have a hysterectomy, the surgeon may attempt to separate the placenta from the uterus. If the patient is not bleeding heavily, the surgeon can take out the section of the uterus attached to the placenta, or alternatively, remove some of the placenta and leave the parts that are attached to the uterus. However, about 40 percent of patients will start to bleed if those tissues are left inside.

• #13 Placenta accreta | Pregnancy Birth and Baby

  https://www.pregnancybirthbaby.org.au/placenta-accreta

  Placenta accreta itself can’t be treated, but there are many things you can do to maximise your chance of a safe birth and minimise the chance of complications. […] If your doctor suspects you have placenta accreta during your pregnancy, they will explain it in detail and discuss with you: what to expect during the rest of your pregnancy, what type of birth is recommended, the recommended timing for birth, as you may need to birth your baby early, the options for managing your placenta once your baby is born. […] You will continue to be closely monitored throughout your pregnancy. It is usually best to give birth in a major hospital with the appropriate medical support. […] In most cases of placenta accreta, it is safest to birth your baby via caesarean. However, if your placenta is high up in the uterus or only stuck in a very small area, you may have more options. Your obstetrician will discuss the safest treatment options to reduce your chance of major blood loss and infection. […] Speak to your doctor about the best management options to reduce your risk of complications.

• #14 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Patients are routinely referred to maternal fetal medicine subspecialists with concerns for suspected invasive placental disorders, either due to risk factors or findings on ultrasound. […] It is advisable whenever possible to refer women with clinical risk factors or worrisome ultrasound findings to centers with experience and expertise in imaging and diagnosis of this condition. […] The risk factors for PAS include prior cesarean delivery, placenta previa, advancing maternal age, prior uterine surgery, multiparity, endometrial ablation, uterine irradiation and smoking. Using these risk factors with the presence/absence of sonographic signs greatly improves the rates of accurate diagnosis of PAS. […] The majority of published guidelines recommend the use of ultrasound for diagnosis of PAS, with magnetic resonance imaging (MRI) use as an adjunct if needed. […] Utilizing ultrasound is likely to decrease the rates of misdiagnosis, and decrease utilization of MRI.

• #15 A novel approach for the early prediction and prevention of placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa: leveraging three-dimensional placental topography, cervical length, and dilatation parameters

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06996-w

  To evaluate the reliability of placental volume and other magnetic resonance imaging (MRI) markers for predicting placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa. […] This study emphasizes the pivotal role of three-dimensional placental volume measurements in the S1 and S2 sectors, along with cervical canal length and dilation, in predicting PAS and severe peripartum hemorrhage in patients with complete placenta previa. Integrating these advanced MRI markers into prenatal care can enhance early detection, improve clinical decision-making, and ultimately improve maternal and fetal outcomes. […] The likelihood of PAS increases from 3% for the first C/S to 67% for the fifth or subsequent C/S. […] Recent studies have elucidated the relationship between shortened cervical canal length (CCL) and adverse outcomes in patients with complete placenta previa (cPP), suggesting that the CCL is a potential prognostic indicator of maternal and fetal health.

• #16 Placenta Accreta – Women’s Health Issues – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/placenta-accreta

  Having had a cesarean delivery, having placenta previa (when the placenta covers the cervix) in the current pregnancy, or both increases the risk of placenta accreta. […] If a woman has risk factors for placenta accreta, doctors do ultrasonography periodically during the pregnancy to check for this complication. […] If the risk of placenta accreta is high, doctors may talk with a pregnant woman about planning a cesarean delivery with a hysterectomy (removing the uterus) a few weeks before the due date. […] If doctors detect placenta accreta before delivery, a cesarean delivery followed by removal of the uterus (cesarean hysterectomy) is typically done. […] This procedure is usually done at about 34 weeks of pregnancy. It helps prevent potentially life-threatening loss of blood, which can occur when the placenta remains attached after delivery. […] However, these techniques cannot be used if bleeding is extremely heavy or is likely to be extremely heavy (because of the placenta’s location).

• #17

  https://journalonsurgery.org/articles/js-v3-1119.html

  Advanced age is also a risk factor for PAS. […] The risk of PAS in older pregnant women (35 years old) is 2.1 times that in women aged 20~34 years. […] PAS patients are prone to massive bleeding, which not only has a great demand for blood transfusion, but also leads to the death of pregnant women, increases the probability of hysterectomy, and prolongs the hospital stay, leading to many adverse outcomes. […] Surgical complications result in higher rates of intensive care unit transfers, higher rates of puerperal infection, and longer hospital stays. […] For patients with multiple uterine surgeries, previous placenta previa and elderly pregnant women, penetrating accreta should be vigilant, and the treatment should be timely and individualized, which is beneficial to improve maternal and infant outcomes.

• #18 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. […] Risk stratification based on clinical indicators would thus be useful in helping to identify subgroups of women at very high risk. […] The combination of these two factors has been identified as a profile at high risk for PAS, and prenatal screening for these disorders is usually performed among this subgroup of women, rather than among all pregnant women. […] Risk factors for PAS were identified by univariate and multivariable logistic regression modelling. […] 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.

• #18 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

  This study suggests a pathophysiological hypothesis related to abnormal decidualization that should be investigated to find specific targets for preventing PAS disorders. […] 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.

• #19 Optimal strategies for conservative management of placenta accreta: a review of the literature

  https://www.jstage.jst.go.jp/article/jsshp/3/1/3_19/_html/-char/en

  The method of conservative management is to leave the placenta in situ to resorb or be expelled spontaneously. Recently, there has been a gradual shift towards conservative management, owing to advances in various methods to reduce blood loss, including adjunctive interventional radiology. […] The aim of this article is therefore to provide a comprehensive review of the literature and of procedures followed in our institution, primarily on the conservative management of placenta accreta. […] A scheduled delivery is desirable as it is associated with reduced blood loss. […] The Royal College of Obstetricians and Gynecologists (RCOG) states that a planned delivery at around 36-37 weeks of gestation (with corticosteroid cover) is a reasonable compromise for high-risk cases for having placenta accreta.

• #19 Optimal strategies for conservative management of placenta accreta: a review of the literature

  https://www.jstage.jst.go.jp/article/jsshp/3/1/3_19/_html/-char/en

  Interventional radiology can save lives and even preserve the uterus in cases of massive obstetric hemorrhage. […] A combination of balloon occlusion in the internal iliac arteries and following embolization is a reasonable stepwise approach to control hemorrhage. […] The following three main strategies involving cesarean section are advocated in the management of placenta accreta. The first strategy is to extirpate both the uterus and the placenta, which is termed a cesarean hysterectomy. The second strategy is to preserve the uterus but extirpate the placenta. […] An alternative to the two previous strategies is the preservation of both the uterus and the placenta. Conservative management includes leaving the placenta in situ, partly or entirely without forced placental removal, awaiting either spontaneous resorption or expulsion.

• #20 Prophylactic Radiologic Interventions for Postpartum Hemorrhage Control in Women With Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-analysis – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11321610/

  Prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may reduce perioperative blood loss. […] Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this meta-analysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before a planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions.

• #21 Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1935-6

  Prophylactic intravenous or oral antibiotics were administered to prevent infection-related complications. […] In our series, UAE, MTX chemotherapy, traditional Chinese medicine, and/or mifepristone followed by curettage under ultrasound guidance were viable adjuvant treatments in the fertility-preserving approach. […] Based on our experience, prophylactic UAE before termination is a necessary and effective procedure, especially for patients with PAS disorders with total placenta previa and previous cesarean delivery.

• #21 Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1935-6

  Leaving the implanted placenta in situ is the preferred choice for patients with PAS disorders who underwent pregnancy termination in the second trimester and desired fertility preservation. […] Multiple adjuvant treatment modalities, either alone or in combination, may help to promote the passing or absorption of the implanted placenta under close monitoring. […] For patients with prenatal suspicion of a diagnosis of PAS disorders, prophylactic uterine artery embolization (UAE) was completed prior to pregnancy termination when there was a risk of severe hemorrhaging and the fetus had a low chance of survival. […] To promote the passing of the implanted placenta and reduce the risk of heavy hemorrhaging and infection, we prescribed certain adjuvant treatments, including UAE, methotrexate (MTX) chemotherapy, traditional Chinese medicine and mifepristone, followed by curettage under ultrasound guidance.

• #22 Optimal strategies for conservative management of placenta accreta: a review of the literature

  https://www.jstage.jst.go.jp/article/jsshp/3/1/3_19/_html/-char/ja

  Interventional radiology can save lives and even preserve the uterus in cases of massive obstetric hemorrhage. […] The adjunctive intervention may cause maternal morbidity, such as, uterine necrosis, vaginal fistula, arteriovenous malformation, arterial thrombosis, and arterial rupture. […] The question remains as to whether or not to perform prophylactic embolization or temporary catheter placement for balloon occlusion. […] The strategy is desirable to prevent unnecessary hysterectomy, but the main disadvantage is the potential for catastrophic hemorrhage. […] The key prerequisites to success are meticulous advance preparations with appropriate resources and facilities. […] Therefore, conservative management often requires adjunctive procedures, including interventional radiology, intrauterine balloon tamponade, and uterine compression suture.

• #22 Optimal strategies for conservative management of placenta accreta: a review of the literature

  https://www.jstage.jst.go.jp/article/jsshp/3/1/3_19/_html/-char/ja

  Placenta accreta is the leading cause of peripartum hysterectomy. While hysterectomy has long been the mainstay of treatment for placenta accreta, there has been a gradual shift over the last decade toward conservative management, both to avoid serious maternal morbidity and to preserve fertility. […] The aim of this paper is to provide a comprehensive literature review regarding management of placenta accreta, especially from the point of view of its conservative treatment and strategies pursued in our practice. […] Preoperative planning is crucial to obtain an optimal outcome in the management of a patient with suspected placenta accreta. […] The delivery should be performed at a tertiary center, and the management necessitates a multidisciplinary team, which may comprise experienced obstetricians, gynecologic oncologists, anesthetists, urologists, general surgeons, interventional radiologists, and neonatologists.

• #23 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. […] When possible, recognition of the need for such care, coordinated antenatal transfer or co-management up until time of delivery, combined with delivery at large regional maternity centers, holds promise to minimize adverse outcomes. […] Prophylactic tranexamic acid given at the time of delivery after cord clamping may reduce the risk of hemorrhage with placenta accreta spectrum. […] Prophylactic use in placenta accreta spectrum is unstudied. […] Taking these limited published data together, and the accepted approach of hysterectomy to treat placenta accreta spectrum, 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.

• #24 Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

  https://www.mdpi.com/2077-0383/13/1/135

  Placenta accreta spectrum (PAS) is associated with high maternal morbidity. […] Expectant management (EM), leaving the placenta in situ after the delivery of the fetus without any manipulation of the placenta, is associated with a more than 50% reduction in blood loss and need for transfusions. […] We aimed to report on the prevention and management of hyperfibrinolysis with TXA during EM of PAS. […] Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. […] Close monitoring during EM is recommended, with weekly follow-ups in the first eight weeks after delivery, with special attention to coagulation parameters in the second month after delivery. […] TXA can safely be used to treat hyperfibrinolysis and prevent severe bleeding complications and should be continued even after normalized coagulation screening.

• #25

  https://journals.lww.com/mfm/fulltext/2021/10000/placenta_accreta_spectrum__conservative_management.7.aspx

  Placenta accreta spectrum is a complication of pregnancy, which poses a great risk on maternal health. […] Recently, the latter has become an approved option that can be offered to women who wish to preserve their future fertility. […] Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. […] The Royal College of Obstetricians and Gynecologists recommends that uterine preserving surgical techniques only be used when surgeons work in an interdisciplinary approach and with appropriate experience to manage such cases. […] The use of MTX, a cytotoxic agent, has been suggested in the conservative treatment of PAS in multiple studies. […] Uterine devascularization can be achieved through several techniques such as iliac artery embolization, bilateral uterine or hypogastric iliac ligation and balloon occlusion in an attempt to prevent secondary postpartum hemorrhage and possibly accelerate placental resolution.

• #26 A Novel Approach in Management of Placenta Accreta Spectrum Disorders: A Single-Center Surgical Experience From Vietnam | Thi Pham | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/812/504

  Placenta accreta spectrum disorder (PASD) is the leading cause which results in highly maternal mortality during pregnancy. […] Although hysterectomy has been the gold standard for PASD, recent data, together with our experience, suggest that conservative management might be better; and thus, we here attempted to determine this. […] The advanced trend in PASD management is conservative surgery and preventing catastrophic blood loss. […] In fact, we have many reliable methods to prevent massive postpartum hemorrhage (PPH) and approach to conservative treatment such as internal iliac artery ligation, leaving the placenta completely or partially in situ with or without selective arterial embolization, the stepwise cesarean delivery technique or modified Triple P procedure (perioperative ultrasound, pelvic vascularization using internal iliac artery balloon catheter, placental non-separation with myometrial excision).

• #26 A Novel Approach in Management of Placenta Accreta Spectrum Disorders: A Single-Center Surgical Experience From Vietnam | Thi Pham | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/812/504

  Uterine conservative surgery was associated with less operative blood loss and blood transfusion amount. […] Thus, this method can be acceptable in PASD management. […] The accurate prenatal diagnosis of PASD contributed to preparing a multidisciplinary team for patient care, from prenatal management to postoperative course, so the planned surgery was up to 59 out of 65 cases. […] Uterine conservative surgery avoided peripartum hysterectomy in 61 cases. […] However, due to the limited sample size as well as retrospective study, so further prospective cohort studies with larger samples are needed to provide robust evidence. […] High uterine preservation surgery plays a pivotal role in saving the reproductive organ of pregnant women with PASD. […] Thereby, further studies are needed to accurately evaluate the success rate of uterine conservative management as well as the uterine dehiscence, fertile function, and complications in later pregnancy.

• #27 Placenta Accreta Spectrum Program | Riley Children’s Health

  https://www.rileychildrens.org/departments/placenta-accreta-spectrum-program

  Endovascular occlusion procedures: Minimally invasive techniques to control bleeding by blocking blood flow. […] Postpartum hemorrhage management: Protocols for managing severe bleeding and massive transfusions. […] Preoperative counseling: Detailed preparation for surgery and recovery, addressing patient concerns. […] Postoperative care: Comprehensive follow-up for optimal recovery and emotional support. […] Multidisciplinary coordination: Seamless care coordination among specialists.

• #28 Chitosan: A new tool for managing Placenta Accreta Spectrum Disorders with uncontrolled hemorrhage

  https://www.oatext.com/chitosan-a-new-tool-for-managing-placenta-accreta-spectrum-disorders-with-uncontrolled-hemorrhage.php

  Placenta accreta spectrum disorder (PASD) is a rare but life-threatening complication of pregnancy. We aimed to describe the use of Chitosan impregnated gauze when managing PASD complicated by uncontrolled bleeding. […] Chitosan is an effective and safe treatment modality in management of life-threatening hemorrhage caused by abnormal placentation when conventional treatment had failed particularly in case of coagulopathy. It can be interesting to consider in isolated health centers, unexperienced teams, or /and unexpected cases. […] In our delivery units, we used an active management of the third stage of labor, which consists of the prophylactic administration of an uterotonic agent prior to placental separation, early cord clamping, and uterine massage. […] Chitosan was not proposed as a first-line treatment but rather a final rescue solution in cases of life-threatening hemorrhage.

• #28 Chitosan: A new tool for managing Placenta Accreta Spectrum Disorders with uncontrolled hemorrhage

  https://www.oatext.com/chitosan-a-new-tool-for-managing-placenta-accreta-spectrum-disorders-with-uncontrolled-hemorrhage.php

  The most important factor with an approach using Chitosan that it does not require a learning curve or prior training. […] We conclude that Chitosan is a new effective therapeutic arsenal to treat uncontrolled hemorrhage secondary to abnormal placentation when conventional resources have failed. It can be an ultimate solution to stop bleeding, temporize to transfer the patient or to correct hemostasis. It is inexpensive, easy to apply and has no side effects. Chitosan is interesting to consider in the management of this high-risk condition especially in isolated health centers, unexperienced teams or /and unexpected cases.

• #29 Management of placenta accreta spectrum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10183858/

  Surgical management of PSA should be performed by professionals with experience in advanced pelvic surgery and skill in dissection of the parametrium, retroperitoneum and pelvic floor, bladder reconstruction, ureter reimplantation and uterine compression suture techniques and uterine and pelvic devascularization. […] If surgical treatment of PAS is impossible or at high risk for uncontrollable bleeding, maintenance of the placenta in situ with counseling about the inherent risks is an acceptable approach.

• #30 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. […] 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.

• #31 Alternative Placenta Accreta Spectrum Treatment Can Improve Outcomes | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/alternative-placenta-accreta-spectrum-treatment-can-improve-outcomes

  Our multidisciplinary approach with a consistentand therefore increasingly experiencedcore team of specialty physicians, nurses, surgical staff, and transfusion services allows us to lead innovations such as the delayed interval hysterectomy described in the consensus statement and fulfill criteria to make us a center for excellence for care of this highly morbid condition, Gilner says.

• #32 Placenta Accreta Pregnancy Complication – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/pregnancy-complications/placenta-accreta

  Currently we do not know how to prevent a placenta accreta when someone is trying to become pregnant. Researchers at BWH, however, are actively studying IVF strategies that may prevent some accretas. Because accreta is strongly associated with having a prior cesarean section or surgery on the uterus, avoiding these surgeries, when possible, may help to prevent some accretas. […] Nevertheless, even though some women with accretas have never had surgery and are not using IVF, we dont know how these women develop accretas or how to prevent them.

• #33 Placenta Accreta Spectrum Overview

  https://www.backtable.com/shows/obgyn/articles/placenta-accreta-spectrum-best-practices-diagnosis-treatment-risk-management

  Dr. Einerson particularly stresses early termination in clear cases where the pregnancy is deep within the scar, as these cases have high potential to turn into difficult, and potentially catastrophic, cases. […] For patients who have bleeding during pregnancy, we have a pretty low threshold to admit though, because our experience is that one bleeding event often leads to an unexpected delivery. […] Our general approach is that we think our best practice based on the current literature and our experience is first of all to, like I said before, to have a pretty healthy skepticism that we are going to know about every case, and as such to overprepare even when we’re not sure of the diagnosis and even when we think the diagnosis is more mild. […] My recommendation for obvious growth into the scar, low implantation, obvious cesarean scar pregnancy in the first trimester is termination of pregnancy by whatever local standard there is. […] I think it’s reasonable to at least consider, if you’re going to get a viability to get comfortable with looking at the location of pregnancy in the uterus is that the outcomes are so much better for early treatment of CSP in that window.

• #34 Optimal strategies for conservative management of placenta accreta: a review of the literature

  https://www.jstage.jst.go.jp/article/jsshp/3/1/3_19/_html/-char/en

  A conservative treatment of placenta accreta was first described in English literature in 1948. […] The key prerequisites to success are meticulous advance preparations with appropriate resources and facilities. It is absolutely imperative that the peripartum bleeding is under control and the patient is in a hemodynamically stable condition. […] Close surveillance is recommended for patients in conservative management. […] Thus, despite absence of any complications, some reports advocate planned prophylactic delayed intervention, such as, abdominal or laparoscopic hysterectomy, hysterescopic resection, dilatation and curettage, or manual removal of the placenta. […] Successful conservative treatment for placenta accreta can allow subsequent pregnancies. […] Thus, the patient and her family should be informed about the high probability of recurrence in future pregnancies. […] The decision on whether to opt for conservative management should be based on the degree of invasion, patients desire for future fertility, and the resources and facilities available for management of placenta accreta.

• #35 Placenta Accreta and Advanced Obstetric Surgical Program

  https://www.massgeneral.org/obgyn/treatments-and-services/placenta-accreta-program

  The Placenta Accreta and Advanced Obstetric Surgical Program in the Department of Obstetrics and Gynecology at Massachusetts General Hospital provides specialized, coordinated multidisciplinary care for pregnant women anticipating potential surgical complications at delivery, including placenta accreta spectrum and related placental complications. […] While it is not always possible, early detection is helpful because it allows for careful treatment planning. […] The most important element for treatment of placenta accreta spectrum and for all anticipated complex delivery is advanced planning with a group of experienced specialists in a hospital with high surgical volumes. […] A coordinated team effort is important because it helps prevent associated surgical complications, such as hemorrhage and/or injury to the nearby organs such as the bladder. […] Outcomes for patients anticipating a complicated surgical delivery drastically improve with advanced planning and with all necessary resources are available for both the patient and her providers.

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