Unexpected Placenta Accreta Spectrum

Dr. Can Ozan Ulusoy1
Assoc. Prof. Dr. Gülşah Dağdeviren2

1Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye

ABSTRACT

Placenta accreta spectrum (PAS) is an obstetric complication characterized by abnormal adherence of the placenta to the uterine wall, potentially invading the myometrium and surrounding tissues. The incidence of PAS has increased alongside rising cesarean section rates. Key risk factors include previous cesarean deliver- ies, placenta previa, advanced maternal age, and previous uterine surgeries. Accurate and timely diagnosis, primarily through transvaginal ultrasonography and magnetic resonans imaging (MRI), is crucial for optimal management and outcomes.

In some cases, PAS may be unexpectedly diagnosed during cesarean delivery, either before or after the uter- ine incision. Management strategies depend heavily on the presence of bleeding and the stability of both the mother and fetus. In stable cases without significant bleeding, surgery may be postponed to ensure the involvement of a qualified surgical team. However, if bleeding occurs or the fetus is at risk, immediate inter- vention is required, often necessitating a hysterectomy.

Future research in PAS should focus on early diagnosis methods, advanced imaging technologies, innovative surgical techniques, multidisciplinary team approaches, and the integration of telemedicine, especially in re- source-limited settings.

Keywords: Placenta accreta spectrum; Intraoperative diagnosis; Telemedicine; Unexpected placenta accreta spectrum; Low-income countries

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