Placenta Accreta Spectrum Disorder in a Patient with Six Previous Caesarean Deliveries: Step by Step Management

Abstract

The definition placenta accreta spectrum disorders (PAS) introduced by FIGO (International Federation of Gynaecology and Obstetrics) indicates an abnormal, pathological adherence or invasion of the placenta. The growing worldwide incidence of this pathological entity, and the possible serious correlated surgical risks, has caused a significant increase in attention among the scientific community. Previous caesarean delivery and presence of placenta previa are the main risk factors for the onset of PAS. Here, we present the intriguing case of a 39-year-old woman, at the 33rd week of gestation, with six previous caesarean sections and with a diagnosis of placenta previa accreta. At our referral center for PAS disorders, we successfully managed this difficult case with the help of a multidisciplinary skilled team.

The Association of Age, Parity, and History of Cesarean Section with the Occurrence of Placenta Accreta Spectrum (Pas) at H. Adam Malik Hospital in Medan 2020-2022

“…More than half of the respondents (56%) had a history of cesarean section ≥2 times, while 44% had a history of cesarean section <2 times. Although cesarean section is important to save lives in pregnancy complications, it still has short and long-term risks [26]. This study is consistent with the findings of Calagna et al, (2021).…”

Bilobed placenta and management choices: liture review and two cases studies

“…Although there is no increased risk of associated fetal abnormalities, the bilobed placenta may be complicated by first trimester bleeding, polyhydramnios, placental abruption and retention. It has been documented that a diagnosis of bilobed placenta can be performed in the first trimester, with a close correspondence at the time of delivery [8][9][10]. Therefore, early diagnosis of anomalous placenta is crucial for patient management, mainly regarding delivery timing.…”

Abnormal placenta implantation. Integration between first‐ and third‐trimester imaging in predicting the severity of Placenta Accreta Spectrum (PAS) disorders

“…[6][7][8] Prenatal diagnosis of PAS is crucial for the purpose of decrease the maternal mortality risk and severe morbidity, including hemorrhage or peripartum hysterectomy, enabling an adequate study and treatment of the case in dedicated centers with skilled, specialized sonographers and surgeons. 2,9,10 Multidisciplinary surgical management, neonatal intensive care, interventional radiology, intraoperative blood availability and an adequate anesthetic support can be effectively activated only after an early suspicion of PAS disorders. 11,12 In the last decade, several studies have focused on the role of ultrasound (US) (using 2D and 3D gray-scale imaging and color Doppler) in the diagnosis of the presence and severity of PAS disorders to predict the risk of severe surgical complications and maternal morbidity.…”

“…Prenatal diagnosis of PAS is crucial for the purpose of decrease the maternal mortality risk and severe morbidity, including hemorrhage or peripartum hysterectomy, enabling an adequate study and treatment of the case in dedicated centers with skilled, specialized sonographers and surgeons 2,9,10 . Multidisciplinary surgical management, neonatal intensive care, interventional radiology, intraoperative blood availability and an adequate anesthetic support can be effectively activated only after an early suspicion of PAS disorders 11,12 …”

“…Placenta accreta spectrum (PAS) disorders are defined as multiple conditions defined by an abnormal adhesion or invasion of trophoblastic tissue within the myometrium, possibly reaching the uterine serosa. 1,2 One or more prior cesarean sections (CS) and placenta previa are known to be the most relevant risk factors for the development of these disorders, although other factors (including in vitro fertilization, prior curettage and myomectomy) have also been shown to significantly growth the risk. 3,4 PAS occurs in about 9.3% of placenta previa and in 0.04% of pregnancies without placenta previa, but this risk rises to 24% when there is a previous CS and 67% in the case of four previous CSs.…”