Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings

Abstract

The purpose of this review is to describe the technical issues associated with managing the placenta accreta spectrum (PAS) disorders in a low-resource setting and to provide insight on how to improve the outcome under these conditions. The available literature recommends managing PAS in a specialized center with a multidisciplinary team (MDT), but there are no standardized management strategies that would help reduce maternal and neonatal morbidity and mortality in a low-resource setting. The increase in the incidence of PAS has been mainly in middle/low-income countries due to high birth and cesarean delivery rates, and thus, there is a need to develop affordable management strategies. Additional techniques for the diagnosis such as MRI and surgical techniques such as balloon occlusion catheters, and other interventional radiology techniques may contribute to reducing maternal morbidities and mortalities in high-income countries but are often not available in a middle/low-resource setting. Similarly, current conservative management techniques can be associated with high complication rates and perinatal costs and thus questionable in a low-resource setting. Within this context, management strategies need to be adapted to local need to reduce both maternal and neonatal complications and costs. New management strategies that can help reduce complication rates and costs of managing PAS in different middle/low-resource settings should be standardized using a cost-benefit analysis. Data analysis should take into account local expertise and should be tailored for local need and access to blood transfusion and adult and neonatal intensive care.