Factors to consider when seeking better results in placenta accreta spectrum

Nieto-Calvache, Álbaro José; Palacios‐Jaraquemada, José Miguel; Aryananda, Rozi Aditya

doi:10.1111/aogs.14214

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…Inclusion criteria were based on the final preoperative diagnosis following preoperative ultrasound imaging consistent with PAS and on intraoperative confirmation during surgery. 13 , 14 , 15 All pregnant women were selected on the basis of specific preoperative ultrasound imaging and intraoperative staging 13 , 15 , 16 , 17 in our hospital, no woman had massive bleeding immediately before surgery, and all surgery was performed as an elective procedure in our hospital. Antepartum hemorrhage in PAS can occur and cause an emergency situation where preoperative diagnosis cannot be made.…”

Section: Methodsmentioning

confidence: 99%

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Aryananda

Aditiawarman

Gumilar

et al. 2022

Acta Obstet Gynecol Scand

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Introduction:The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. Material and methods: A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservativeresective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries).Results: Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In subanalysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio[OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL)

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Section: Methodsmentioning

confidence: 99%

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Aryananda

Aditiawarman

Gumilar

et al. 2022

Acta Obstet Gynecol Scand

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“…According to the SMFM guidelines, the role of iliac artery occlusion (internal and common arteries) is still controversial as it has been reported to decrease blood loss in some studies but showed no difference in others [2]. It also has been postulated that PAS is associated with neovascularisation and abnormal blood supply therefore occluding pelvic vessels may exacerbate bleeding from the collateral circulation, thus limiting the benefit of this procedure [17][18][19][20][21][22][23][24][25][26]. International Federation of Obstetrics and Gynecology (FIGO) does not recommend its routine use due to a lack of strong supporting evidence of their benefit [1].…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum (PAS) Disorders: Lessons Learned from the Introduction of Different Management Strategies in an Australian Tertiary Hospital. Retrospective Study (2004 to 2020)

Caldas¹,

Parr²,

Adno³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Placenta accreta spectrum (PAS) disorder refers to pathologic adherence of the placenta and presents multiple perinatal challenges, accounting for between 30-50% of emergency peripartum hysterectomies. Accurate prenatal diagnosis allows multidisciplinary management and delivery at centres with experience and has been shown to improve perinatal outcomes. This study aims to analyse the results of implementing different strategies across the years on the diagnosis and management of PAS in a tertiary Australian hospital (Liverpool Hospital) including: the use of magnetic resonance imaging (MRI) and the benefits of the use of iliac artery balloons and ureteric stents. Secondary objectives include analysis of the risk factors and outcomes. Methods: Retrospective case series of 34 pregnancies complicated by PAS disorders, diagnosed between 2004 and 2020, and delivered at Liverpool Hospital. Descriptive and analytic study (with a significance level of p ≤ 0.05), approved by the Research Ethics and Governance Information System. Results: The incidence of PAS was 0.6 per 1000 deliveries. The typical risk factors (previous uterine surgeries and placenta praevia) were present in 79% of the cases. MRI was used in 39% of the cases (when ultrasound was inconclusive or placenta posterior) and was only inconclusive in 1 case. In total, 32% required emergency delivery due to haemorrhage or preterm labor. The overall complications rate was 32%. Ureteric stents were used in 44% of the cases and there were no ureteric injuries. The use of iliac balloons reduced the total blood loss (2.5 L compared to 2.8 L), however this difference was not statistically significant (p = 0.21). Conclusions: The prenatal diagnosis of PAS is essential to allow optimal perinatal management of these cases. The use of MRI appears helpful when ultrasound is inconclusive. In our study, the use of iliac balloons reduced blood loss, although this was not statistically significant, and ureteric stents appeared useful to avoid ureteric injury in the most complex cases, although the sample is very small. We hope that our study will help us improving our clinical practice.

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“…Sector S2 is vascularized by deep vessels, which significantly increases surgical complexity and presents an increased risk of hemorrhage [13] . S1/S2 uterine sector classification can provide important information for surgical strategies, especially the use of aortic control during surgery [14 , 15] .…”

Section: Discussionmentioning

confidence: 99%

Lifesaving diagnosis of placenta accreta spectrum using MRI: Report of five cases

Koesmarsono

Aryananda

Ariani

et al. 2022

Radiology Case Reports

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Factors to consider when seeking better results in placenta accreta spectrum

Cited by 10 publications

References 4 publications

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Placenta Accreta Spectrum (PAS) Disorders: Lessons Learned from the Introduction of Different Management Strategies in an Australian Tertiary Hospital. Retrospective Study (2004 to 2020)

Lifesaving diagnosis of placenta accreta spectrum using MRI: Report of five cases

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