Optimal strategies for conservative management of placenta accreta: a review of the literature

Kondoh, Eiji; Kawasaki, K.; Chigusa, Yoshitsugu; Mogami, Haruta; Ueda, Akihiko; Kawamura, Yosuke; Konishi, Ikuo

doi:10.14390/jsshp.3.19

Cited by 4 publications

(24 citation statements)

References 101 publications

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“…2,3,5 Thus, intervention for retained placenta is not recommended for uncomplicated patients. 2,3,5 We think that massive bleeding can occur as long as the placental blood flow remains. In a small case series, placental blood flow disappeared on average in 8.9 AE 1.7 weeks, and the loss of placental blood flow was almost coincident with the reduction in human chorionic gonadotropin (hCG) to undetectable levels.…”

Section: Postoperative Managementmentioning

confidence: 99%

“…The attempt can avoid unnecessary complications such as delayed hemorrhage, infection, and coagulopathy, and longterm surveillance in expectantly managed false-positive PAS. 3 How to deal with hemorrhage depends on the degree of spontaneous detachment of the placenta. 3 If the placenta is completely separated from the uterus, the actual diagnosis is placenta previa, which can be safely managed with intrauterine balloon tamponade.…”

Section: Minimizing Perioperative Blood Lossmentioning

confidence: 99%

“…Coagulopathy is rare, but can occur with expectant management. 3,5,6 Therefore, regular follow-up tests include ultrasonography, a speculum examination, complete blood count, C-reactive protein, hCG, and coagulation tests (prothrombin time, activated partial thromboplastin time, fibrinogen). Follow-up is set weekly and then biweekly to monthly.…”

Section: Postoperative Managementmentioning

confidence: 99%

“…2 Magnetic resonance imaging (MRI) may improve the diagnosis of PAS located in the posterior wall where ultrasound findings are inconclusive. 2,3 In addition, MRI can help to plan surgical strategies for PAS, as it can provide more comprehensive and detailed information about the location of the placenta, the uterus, and the adjacent organs. 3 The antenatal diagnosis of PAS provides an opportunity for in-depth planning and a multidisciplinary team approach.…”

mentioning

confidence: 99%

“…2,3 In addition, MRI can help to plan surgical strategies for PAS, as it can provide more comprehensive and detailed information about the location of the placenta, the uterus, and the adjacent organs. 3 The antenatal diagnosis of PAS provides an opportunity for in-depth planning and a multidisciplinary team approach. The average perioperative blood loss for PAS is $3,000 to 5,000 mL.…”

mentioning

confidence: 99%

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Expectant Management of Placenta Accreta Spectrum Disorders

Kondoh

2021

Surg J (N Y)

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Placenta accreta spectrum (PAS) disorder is a potentially life-threatening complication. The incidence of PAS has increased over the past few decades, mainly due to the increased cesarean section rate. While cesarean hysterectomy remains the most standard treatment for the management of PAS, expectant management is becoming increasingly prevalent to avoid serious maternal morbidity and maintain future fertility. Expectant management is defined as leaving the placenta either partially or fully in situ, and waiting for its spontaneous resorption or expulsion. The success rate of expectant management is high, but intraoperative uncontrolled hemorrhage results in hysterectomy. Moreover, some individuals fail expectant management and require delayed hysterectomy due to complications such as secondary postpartum hemorrhage, sepsis, uterine necrosis, and vesicouterine fistula. As a result of the very limited data currently available, there is no consensus on the optimal strategy for the expectant management of PAS. However, it is clear that a multidisciplinary team approach in tertiary centers is essential for women with PAS. In addition, meticulous preparation is the key to successful expectant management. Here, we describe a surgical strategy designed to reduce perioperative blood loss, which is a minimum requirement to ensure maternal safety. This article also addresses practical issues in expectant management of PAS, based on the published literature and our own experience.

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