Management and Outcome of Women with Placenta Accreta Spectrum

Richard Patricia^*
*Correspondence: Richard Patricia, Department of Cardiology, University of Portland, 5000 N Willamette Blvd, Portland, OR 97203, USA, Email:

Introduction

Placenta Accreta Spectrum (PAS) disorders represent a significant challenge in modern obstetrics, posing considerable risks to maternal and fatal health. PAS encompasses a range of abnormalities involving abnormal placental adherence to the uterine wall, including placenta accreta, increta, and excreta. These conditions have been on the rise, paralleling the increasing rates of caesarean deliveries and other uterine surgeries. Effective management of PAS requires a multidisciplinary approach, involving obstetricians, maternalfetal medicine specialists, anaesthesiologists’, radiologists, and sometimes, urologists and vascular surgeons. This article aims to discuss the current strategies for the management and outcomes of women diagnosed with PAS [1].

The incidence of PAS has been steadily increasing over recent decades, with rates varying globally. Contributing factors include the rising rates of caesarean deliveries, advanced maternal age, multiparty, previous uterine surgeries, and placenta praevia. Understanding these risk factors is crucial for early identification and appropriate management of PAS. PAS is often suspected based on clinical findings such as abnormal placentation or history of risk factors. However, definitive diagnosis typically requires imaging modalities such as ultrasound and Magnetic Resonance Imaging (MRI). These tools aid in determining the extent of placental invasion and guiding subsequent management decisions. The management of PAS depends on several factors, including the severity of placental invasion, gestational age, maternal condition, and the desire for future fertility. The primary goals of management are to optimize maternal outcomes while minimizing maternal morbidity and preserving fertility whenever possible [2].

Description

Early identification of PAS allows for comprehensive counselling regarding the risks and management options available. Delivery planning is crucial in minimizing haemorrhagic complications. Caesarean hysterectomy may be recommended in severe cases, preferably performed in specialized centers equipped to handle complex obstetric surgeries. Selective arterial embolization and prophylactic internal iliac artery balloon catheterization (IIABC) may be considered to reduce intraoperative bleeding during delivery. Intraoperative management involves collaboration among obstetricians, anaesthesiologists, and surgical specialists to ensure optimal outcomes [3].

Techniques such as uterine artery ligation, stepwise placental removal, and bladder flap dissection are employed to minimize blood loss and preserve fertility when feasible. Blood products should be readily available, and techniques such as cell salvage and tranexamic acid administration may be utilized to reduce the need for allogeneic transfusions. Close postoperative monitoring in an intensive care setting is often warranted, particularly in cases with significant hemorrhage or hemodynamic instability. Prompt recognition and management of complications such as Disseminated Intravascular Coagulation (DIC), infection, and urological injuries are essential for optimal recovery.

Despite advances in obstetric and surgical care, PAS remains associated with significant maternal morbidity and mortality. Complications such as hemorrhage, hysterectomy, bladder injury, and need for blood transfusions are common. Long-term sequelae may include infertility, pelvic adhesions, and the need for subsequent caesarean deliveries. However, with timely diagnosis, appropriate management, and access to specialized care, maternal outcomes can be improved, and fertility preservation can be optimized in select cases [4]. Continued research into the pathophysiology, risk factors, and optimal management strategies for PAS is essential. This includes the development of novel imaging techniques for early diagnosis, refinement of surgical techniques to minimize morbidity, and exploration of adjunct therapies to improve outcomes [5].

Conclusion

Placenta Accreta Spectrum disorders presents a significant challenge in contemporary obstetrics, requiring a multidisciplinary approach for optimal management. Early recognition, comprehensive prenatal counselling, and timely intervention are crucial for improving maternal outcomes and preserving fertility. Continued collaboration among obstetricians, surgical specialists, and ancillary support services is essential in mitigating the morbidity associated with PAS and improving the long-term health of affected women.

Acknowledgement

None.

Conflict of Interest

None.

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