Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital

Maison, Nuttaporn; Rattanaburi, Athithan; Pruksanusak, Ninlapa; Buhachat, Rakchai; Tocharoenvanich, Sathana; Harnprasertpong, Jitti; Saeaib, Nungrutai; Suphasynth, Yuthasak; Atjimakul, Thiti; Pichatechaiyoot, Aroontorn; Jiamset, Ingporn; Nanthamongkolkul, Kulisara

doi:10.1080/01443615.2021.1910638

Cited by 8 publications

(17 citation statements)

References 34 publications

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“…PAS also involves increased rates of organ injuries and ICU admissions and longer hospital stays, as found in our study and other studies [11,13,35,36]. Our study was done in the main tertiary referral center for managing PAS in the south of Thailand, where the incidence of PAS has been increasing for several years now and recently reported the very high rate of 1:161 deliveries [10]. The average blood loss in PAS during the study period was 2500 mL, which is in the same range as other studies [34][35][36][37].…”

Section: Discussionsupporting

confidence: 82%

“…The scoring system of Tovbin et al [24] focused on the probability of a PAS diagnosis but was not related to clinical outcomes. The study of Cali G et al [11] showed correlations between a group of ultrasound findings and the FIGO 2018 clinical grading system which were related to clinical outcomes, however, the hemorrhagic outcomes of this study were much lower than in previous studies, [10,12,28,34,35] even in the most severe group, which may reflect different management protocols among the centers.…”

Section: Plos Onecontrasting

confidence: 81%

“…Our scoring system is based on the 2D ultrasound technique which is available in all hospitals, is not expensive and does not need extra training as with 3D ultrasound or MRI. Also, our institution reported high accuracies in diagnosing PAS of between 91 and 94% [10], similar to other PAS centers [43,44]. In our center, we have a dedicated PAS surgical care team in which all surgeons are gynecologic oncologists with many years of experience in difficult surgical conditions such as PAS, so the average amount of blood loss in our study may have been less than in studies from other centers which may have been influenced by factors such as surgeon PLOS ONE experience, surgical technique, accuracy of prenatal diagnosis, etc.…”

Section: Plos Onementioning

confidence: 58%

“…The subgroups of PAS which can cause life-threatening hemorrhage are placenta increta and percreta, which are defined as abnormally invasive placenta (AIP) and less likely to respond to conservative management [2][3][4]. The incidence of PAS has been increasing globally in recent years, mainly because cesarean rates have increased to 1:220-533 births worldwide [5][6][7], with the largest increases found in developing countries [5,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

2022

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Objective To evaluate certain two-dimensional (2D) ultrasound signs as predictors of massive peri-operative blood loss (PBL) in pregnant women with placenta previa suspicious of PAS disorder. Materials and methods A single center retrospective study was done in pregnant women who had undergone prenatal diagnosis with 2D ultrasound grey scale and color Doppler using the EW-AIP (which has been changed to IS-PAS (International Society for the Placenta Accreta Spectrum)) criteria between January 2007 and May 2021. The patients were divided into 2 groups, non-massive hemorrhage with PBL ≤ 2500 mL and massive PBL >2500 mL. All PAS cases had pathological confirmation. Ultrasound signs and hemorrhagic outcomes were compared between the two groups. A PAS scoring system to predict massive PBL was constructed and a receiver operating characteristic (ROC) curve was calculated to evaluate the efficacy of the scoring system. Results Of 534 women, 146 (28.3%) had PBL > 2500 mL and 388 (71.7%) had PBL ≤ 2500 mL. In the massive PBL group, 101 (69.2%) were diagnosed as PAS and 45 (30.8%) as placenta previa alone. From 10 evaluated 2D ultrasound signs, 3 had the highest odds ratios (ORs) associated with massive PBL, ‘focal exophytic mass’ OR 8.17 (p = 0.024), ‘placental bulge’ OR 2.47 (p = 0.011), and ‘placental lacunae feeder vessels’ OR 2.38 (p = 0.01). When using the PAS scoring system, the AUC to predict massive PBL was 0.80 (95% CI, 0.76–0.85,). Conclusion Our PAS scoring system based on 2-dimensional ultrasound signs combined with grey scale and color Doppler is useful to predict massive PBL and can help optimize pre-operative management in cases of previa suspicious of PAS.

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Section: Discussionsupporting

confidence: 82%

Section: Plos Onecontrasting

confidence: 81%

Section: Plos Onementioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

2022

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“…In contrast, a recent study on the hemorrhagic morbidity of antenatally suspected PAS cases, Maison et al showed that intraoperative hemorrhagic morbidity was highest in cases requiring emergency delivery before 34 weeks of gestation. However, in stable cases intraoperative blood loss was lowest at 36–36 +6 gestational weeks 13 . Similarly, Rac et al found that emergency delivery for bleeding decreased significantly with advancing pregnancy, 71% of the cases delivered at 36 weeks of gestation and beyond, and more than 90% of the cases had no bleeding complications 36 .…”

Section: Discussionmentioning

confidence: 99%

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center

Gölbaşı

Bayraktar

Gölbaşı

et al. 2022

Z Geburtshilfe Neonatol

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Objectives To evaluate the maternal and neonatal outcomes of expected and unexpected pathologically proven placenta accreta spectrum (PAS) cases in a single multidisciplinary center. Material and Methods This was a retrospective cohort study of 92 PAS cases from January 2011 until September 2021. Only cases with histopathologically invasive placentation were included in the study. The cases diagnosed at the time of delivery were defined as unexpected PAS (uPAS) and those diagnosed antenatally as expected PAS (ePAS). Maternal and neonatal outcomes of both groups were compared. Results Thirty-five (38%) of 92 cases were in the uPAS group. Placenta previa and high-grade PAS (percreata) were significantly higher in the ePAS group (p=0.028, p<0.001; respectively). The mean packed red blood cell transfusion was significantly higher in the uPAS group (p=0.030) but transfusions of other blood products were similar in the two groups. There was no significant difference in intraoperative complication rates between the two groups. Preterm delivery (<37 weeks) was significantly higher in the ePAS group (p<0.001), but there was no significant difference between the two groups in terms of adverse neonatal outcomes. Conclusions Our single center data show that although ePAS cases include more highly invasive PAS cases, maternal hemorrhagic morbidity is lower than uPAS cases. Reducing maternal morbidity in PAS cases can be achieved by increasing antenatal diagnosis.

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Effective training program for antenatal diagnosis of placenta accreta spectrum disorder

Watcharasin

Pranpanus

Suwannanon

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo develop and evaluate a training program for diagnosing placenta accreta spectrum (PAS) disorder in obstetrics/gynecology and radiology residents.MethodsThis single‐center prospective study was based on 177 ultrasound images of pathologically confirmed PAS extracted from 534 cases of placenta previa suspicious for PAS. First‐ to third‐year residents were evaluated before training to assess experience and ability to diagnose PAS. They attended a principal lecture followed by weekly self‐study exercises over 5 weeks. Post‐course tests evaluated the efficacy of the training program for improving diagnosis of PAS after the program.ResultsTwenty‐three (38.3%) obstetrics/gynecology and 37 (61.7%) radiology residents were trained. Before the training program, 98.3% reported minimal experience and 100% low confidence to correctly diagnose PAS. During the program, the overall accuracy of all participants in diagnosing PAS increased from 71.3% before to 95.2% after training (P < 0.001). Regression analyses showed that ability to diagnose PAS increased 2.52‐fold (P < 0.001) following the program. The retention of knowledge at 1, 3, and 6 months posttest was 84.7%, 87.5%, and 87.7%, respectively.ConclusionAn antenatal diagnosis of PAS training program can be effective as a residency training program, considering the globally rising cesarean delivery rates.

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Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital

Cited by 8 publications

References 34 publications

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center

Effective training program for antenatal diagnosis of placenta accreta spectrum disorder

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