Outcomes Following a Clinical Algorithm Allowing for Delayed Hysterectomy in the Management of Severe Placenta Accreta Spectrum

Abstract

(Am J Obstet Gynecol. 2020;222:179.e1–179.e9) Placenta accreta spectrum (PAS) is a major risk factor for maternal injury and death, with an estimated morbidity rate of 24% to 67% and an estimated mortality rate of up to 7%. The current recommendations for treatment of PAS focus on immediate cesarean hysterectomy, but given the significant morbidity of PAS, new treatment strategies are needed. This study assessed the outcomes of patients with an antenatal diagnosis of placenta percreta that was managed with delayed hysterectomy versus patients who had an immediate cesarean hysterectomy.

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

“…The risks of severe bleeding and visceral injury during cesarean hysterectomy should be balanced with the risk of infection, bleeding and emergency hysterectomy if the placenta is left in situ. 19 In a recent report on a large series on focal resection in PAS, a complication rate of 40.5% was reported. 20 In referral centers for PAS, a broad spectrum of measures is available, including suturing techniques, iliac balloon, hemostatic tamponades, conservative management protocols and embolization, which are individually employed according to PAS grade and local preference.…”

Authors’ reply re: Vascular Control by Infrarenal Aortic Cross-Clamping in Placenta Accreta Spectrum Disorders: description of technique. (Response to BJOG-20-2523)

“…An experienced multidisciplinary team approach (3) and delayed hysterectomy at 4 to 6 weeks interval after cesarean delivery may represent two of the optimum strategies for minimizing the degree of hemorrhage in the most severe patients; the latter approach allows time for uterine blood flow to decrease and for the placenta to regress from surrounding structures in situations in which immediate hysterectomy is deemed too dangerous (5).…”

Preserve the Uterus For Placenta Accreta Spectrum Overlying Cesarean Scar: a Step-by-step Surgical Technique

“…[2][3][4] Delayed hysterectomy after cesarean delivery with the placenta left in situ, was also reported to decrease blood loss. [5][6] However, this approach need two major surgeries, and the delay poses a risk of bleeding or infection that may require emergency surgery.…”