Abstract
Background The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass. Conclusions Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.
Highlights
The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management
Antenatal diagnosis and making no attempt to remove any part of the placenta is associated with reduced levels of haemorrhage and less blood transfusions [3, 4]
Strict patient selection is of paramount importance since it may be associated with a higher risk of morbidity and emergency hysterectomy
Summary
The incidence of placenta accreta, increta, and percreta, collectively called placenta accreta spectrum (PAS) disorders, has been rising dramatically over the last decade worldwide, mainly due to a rising caesarean delivery (CD) rate [1, 2]. Antenatal diagnosis and making no attempt to remove any part of the placenta is associated with reduced levels of haemorrhage and less blood transfusions [3, 4]. Conservation of the uterus reduces numerous short- and long-term complications including massive blood transfusions, disseminated intravascular coagulopathy (DIC), high morbidity/mortality rates, adjacent pelvic organ damage, and infection, as well as long-term psychological sequelae due to the loss of femininity and fertility [5, 6]. The scope of this article is to describe a model for the follow-up of the conservative management of PAS with the placenta in situ approach, while summarizing the followup findings of three PAS cases managed in University Unit of Obstetrics and Gynecology, Ragama, Sri Lanka during 2017 and 2018. The placental volume was calculated using a 2-dimensional ultrasound scan by measuring the maximum length and anteroposterior and transverse diameters of the uterus and using the formula for the volume of a prolate ellipsoid
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