Placental Adhesive Disorders

FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,

“…The main steps in this uterine‐sparing technique can be performed via a modified Pfannenstiel or midline incision (Box 1). It is advantageous for low‐ and middle‐income countries where expensive additional treatments such as interventional radiology may not be available.…”

“…This surgical procedure has been described primarily by one author. 3,51,52 It consists of resecting the invasive accreta area (partial myometrial resection) followed by immediate uterine reconstruction and bladder reinforcement. 51 This strategy aims to combine the advan-…”

Placenta accreta treated with planned caesarean hysterectomy

“…25 The main stages of this alternative technique achieved through a median or transverse suprapubic incision are a) vascular disconnection of newly-formed vessels and the separation of invaded uterine from invaded vesical tissues; b) performing an upper-segmental hysterectomy; c) resection of all invaded tissue and the entire placenta in one piece with previous local vascular control; d) use of surgical procedures for haemostasis; e) myometrial reconstruction in two planes and f) bladder repair if necessary. 26 This procedure does not appear to alter the subsequent obstetrical outcome. Palacios-Jaraquemada has reported 45 pregnancies following a one stepprocedure for placenta accreta.…”

“…[24][25][26] It consists of resecting the invaded area together with the placenta and performing the reconstruction as a one-step procedure. 25 The main stages of this alternative technique achieved through a median or transverse suprapubic incision are a) vascular disconnection of newly-formed vessels and the separation of invaded uterine from invaded vesical tissues; b) performing an upper-segmental hysterectomy; c) resection of all invaded tissue and the entire placenta in one piece with previous local vascular control; d) use of surgical procedures for haemostasis; e) myometrial reconstruction in two planes and f) bladder repair if necessary.…”

MRI evaluation of the placenta from normal variants to abnormalities of implantation and malignancies

“…The main risk factors contributing to the development of abnormal placentation include previous cesarean delivery, placenta previa, history of prior myomectomy or other uterine surgeries, prior uterine curettage, and advanced maternal age . The most important risk factor is placenta previa in the presence of a uterine scar . A previous C‐section increases the odds by ~8.7 and the risk increases with an increase in the number of previous C‐sections .…”