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
Referanslar
- Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand. 2013 Apr;92(4):457-60. [Crossref] [PubMed]
- Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ul- trasound imaging. Am J Obstet Gynecol. 2018 Jan;218(1):75-87. [Crossref] [PubMed]
- Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Ga- rofalo A, et al. Third-trimester ultrasound for antenatal diag- nosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol. 2022 Sep;60(3):381 https://pubmed.ncbi.nlm. nih.gov/35247287/ https://obgyn.onlinelibrary.wiley.com/ doi/10.1002/uog.24889 [Crossref]
- Barzilay E, Brandt B, Gilboa Y, Kassif E, Achiron R, Ra- viv-Zilka L, et al. Comparative analysis of ultrasound and MRI in the diagnosis of placenta accreta spectrum. J Ma- tern Fetal Neonatal Med. 2022 Nov;35(21):4056-9. [Crossref] [PubMed]
- Silveira C, Kirby A, Melov SJ, Nayyar R. Placenta ac- creta spectrum: We can do better. Aust N Z J Obstet Gy- naecol. 2022 Jun;62(3):376-82. [Crossref] [PubMed]
- Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists and the Society for Mater- nal-Fetal Medicine, Cahill AG, Beigi R, Heine RP, Silver RM, et al. Placenta Accreta Spectrum. Am J Obstet Gyne- col. 2018 Dec;219(6):B2-16. [Crossref] [PubMed]
- Erfani H, Fox KA, Clark SL, Rac M, Rocky Hui SK, Re- zaei A, et al. Maternal outcomes in unexpected placen- ta accreta spectrum disorders: single-center experience with a multidisciplinary team. Am J Obstet Gynecol. 2019 Oct;221(4):337.e1-337.e5. [Crossref] [PubMed]
- Adwan D, Hamed A, Albokai M, Alabdulrazak MA. Man- agement of PAS in Low-Resource Settings. In: Shazly SA, Nassr AA, editors. Placenta Accreta Spectrum: Basic Sci- ence, Diagnosis, Classification and Management. Cham: Springer International Publishing; 2023. p.161-83. [Crossref]
- Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015 May;212(5):561-8. [Crossref] [PubMed]
- American College of Obstetricians and Gynecologists, So- ciety for Maternal-Fetal Medicine. Obstetric Care Con- sensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018 Dec;132(6):e259-75. [Crossref] [PubMed]
- Aryananda RA, Nieto-Calvache AJ, Duvekot JJ, Aditi- awarman A, Rijken MJ. Management of unexpected placenta accreta spectrum cases in resource-poor settings. AJOG Glob Rep. 2023 May;3(2):100191. [Crossref] [PubMed]
- Munoz JL, Einerson BD, Silver RM, Mulampurath S, Sherman LS, Rameshwar P, et al. Serum exosomal microRNA pathway activation in placenta accreta spectrum: pathophysiology and detection. AJOG Glob Rep. 2024 Feb;4(1):100319. [Crossref] [PubMed]
- Rupley DM, Tergas AI, Palmerola KL, Burke WM. Robot- ically assisted delayed total laparoscopic hysterectomy for placenta percreta. Gynecol Oncol Rep. 2016 Aug;17:53-5. [Crossref] [PubMed] [PMC]
- Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol. 2012 Jul;120(1):207-11. [Crossref] [PubMed]