A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum

Beekhuizen, Heleen J. van; Stefanović, Vedran; Schwickert, Axel C.; Henrich, Wolfgang; Fox, Karin A.; Gzirí, Mina Mhallem; Sentilhes, Loïc; Grønbeck, Lene; Chantraine, Frédéric; Morel, O.; Bertholdt, Charline; Braun, Thorsten; Rijken, Marcus J.; Duvekot, Johannes J.; Calda, Pavel; Chalubinski, Kinga; Collins, Sally; Martinelli, Pasquale; Morlando, Maddalena; Nonnenmacher, A; Pateisky, Petra; Petit, Philippe; Ropacka, M.; Tikkanen, Minna; Tutschek, B.; Weichert, Alexander; Weizsäcker, Katharina

doi:10.1111/aogs.14096

Cited by 29 publications

(22 citation statements)

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“…A multidisciplinary team of obstetricians, gynecologist, vascular surgeons, interventional radiologists, urologists, and hematologists in referral centers increases accuracy of the diagnosis, and subsequent management by experts reduces maternal morbidity and mortality. [ 34 , 35 ] In our hospital, the strategy of a planned cesarean section included blood typing, cross-matching of at least 2 units of packed red cells, and invitation of multiple team works. In planned cases of cesarean hysterectomy, we used a midline vertical incision to minimize dissection of tissue planes and provide good visualization of the abdomen and pelvis.…”

Section: Discussionmentioning

confidence: 99%

Emergent versus planned delivery in patients with placenta accreta spectrum disorders

et al. 2021

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The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam. The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed. A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 ± 0.33 vs 4.5 ± 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group ( P < .001). The mean gestational age at delivery for the emergent group was 35.1 ± 0.27 weeks compared with 38.0 ± 0.10 weeks for the planned group ( P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59–5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13–14.29). Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

Emergent versus planned delivery in patients with placenta accreta spectrum disorders

et al. 2021

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“…Management strategies include delivery by planned cesarean hysterectomy, focal myometrial resection and conservative management leaving the placenta in situ after delivery, with or without adjunctive measures such as arterial embolization or planned delayed hysterectomy. 6 Various efforts have been made to identify associations between clinical management and maternal blood loss, morbidity and mortality in PAS. Most studies are conducted by single centers, with limited data and generalizability to guide the optimal management of this condition.…”

Section: Introductionmentioning

confidence: 99%

Association of Peripartum Management and High Maternal Blood Loss at Cesarean Delivery for Placenta Accreta Spectrum (PAS): A Multinational Database Study

Schwickert¹,

Beekhuizen²,

Bertholdt³

et al. 2022

Obstetric Anesthesia Digest

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“…Not only is PAS a heterogeneous disease spectrum, but management of pregnancies with PAS varies widely across centers. Management strategies include delivery by planned cesarean hysterectomy, focal myometrial resection and conservative management leaving the placenta in situ after delivery, with or without adjunctive measures such as arterial embolization or planned delayed hysterectomy 6 …”

Section: Introductionmentioning

confidence: 99%

Association of peripartum management and high maternal blood loss at cesarean delivery for placenta accreta spectrum (PAS): A multinational database study

Schwickert

Beekhuizen

Bertholdt

et al. 2021

Acta Obstet Gynecol Scand

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A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum

Abstract: International Society of Placenta Accreta Spectrum (IS-PAS) group are listed in Appendix 1.

Cited by 29 publications

References 20 publications

Emergent versus planned delivery in patients with placenta accreta spectrum disorders

Emergent versus planned delivery in patients with placenta accreta spectrum disorders

Association of Peripartum Management and High Maternal Blood Loss at Cesarean Delivery for Placenta Accreta Spectrum (PAS): A Multinational Database Study

Association of peripartum management and high maternal blood loss at cesarean delivery for placenta accreta spectrum (PAS): A multinational database study

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