Abstract
Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.
Highlights
Placenta accreta spectrum (PAS) is a term used to describe abnormal placental invasion, including placenta accreta, increta and percreta [1]
In the case of women with a prior single cesarean delivery, the presence of placenta previa is associated with a 3% risk of placenta accreta spectrum (PAS), while the absence of placenta previa is associated with a 0.03% risk of PAS
The patients with placenta previa associated with PAS were divided into two groups according to the PAS risk factors: group A (83.33%) had only one prior cesarean delivery, and group B (16.67%) had two cesarean deliveries
Summary
Placenta accreta spectrum (PAS) is a term used to describe abnormal placental invasion, including placenta accreta (penetration 50% of the myometrium) and percreta (penetrates beyond the myometrium to the uterine serosa and adjacent organs) [1]. The principal societies – International Federation of Gynaecology and Obstetrics (FIGO) [2], Royal College of Obstetricians and Gynaecologists (RCOG) [3] and the American College of Obstetricians and Gynecologists (ACOG) [4] – defined the term placenta accreta spectrum (PAS), with all grades of abnormal placentation (Figure 1). It is a consequence of a defective decidualization determined by placental implantation at an area of preexisting damage to the endometrial-myometrial interface [5]. Women over 35 years or with a personal history of pelvic irradiation, manual removal of the placenta, endometritis, or infertility have a higher PAS risk compared to control groups [8]
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