Patient selection for later delivery timing with suspected previa‐accreta

Perlman, Nicola C.; Little, Sarah E; Thomas, Ann; Cantonwine, David E.; Carusi, Daniela

doi:10.1111/aogs.13140

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…For 52 women (26.3%) in our study population, gestational age at the time of delivery was ≥ 37 weeks, which had no significant association with blood loss and/or post operative complications. It seems that this finding is in association with the recent publications that suggested physicians can decide case by case for PAS termination and it is not necessary to terminate all cases at the 34 weeks’ of gestation [ 28 ].…”

Section: Discussionsupporting

confidence: 76%

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

et al. 2021

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Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.

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Section: Discussionsupporting

confidence: 76%

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

et al. 2021

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“…The third study of 84 women who had reached 34 +0 weeks of gestation with a suspected praevia accreta found that those with no risk factors for preterm birth are at low risk for an unscheduled delivery prior to 36 weeks of gestation. 170 Evidence level 2+…”

Section: 4mentioning

confidence: 99%

Placenta Praevia and Placenta Accreta: Diagnosis and Management

Jauniaux¹,

Alfirević²,

Bhide³

et al. 2018

BJOG

424

415

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“…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 . Perlman et al evaluated PAS cases by classifying them according to preterm delivery risk factors and found that cases without preterm delivery risk had a low risk of unplanned delivery before 36 weeks of gestation 37 . In 2018, RCOG reported that planned delivery at 35+0 to 36+6 gestational weeks provides the best balance between fetal maturity and the risk of unplanned delivery in PAS cases without risk factors for preterm delivery 15 .…”

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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Patient selection for later delivery timing with suspected previa‐accreta

Abstract: Patients with suspected previa-accreta and no risk factors for preterm birth are at low risk for an unscheduled delivery prior to 36 weeks. Those with no concern for percreta or increta or no prior cesarean section may also be candidates for later delivery.

Cited by 19 publications

References 25 publications

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

Placenta Praevia and Placenta Accreta: Diagnosis and Management

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

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