VP44.20: Experience of a multidisciplinary team for management on placenta accreta spectrum disorders: ultrasound findings and clinical outcomes

Abstract

Placenta accreta spectrum (PAS) disorders are among the leading causes of maternal morbimortality. The prenatal diagnosis of PAS disorder by ultrasound (US) allows multidisciplinary planning in an attempt to minimise the risk of maternal or neonatal morbidity and mortality. The aim of this study was to review cases of PAS focusing on US signs and comparing it with the surgical or histopathological findings. Retrospective analysis including all cases of PAS diagnosed between January 2018 and June 2021. After publications of FIGO guidelines on PAS disorders, a dedicated team was set up in order to optimise maternal and neonatal outcomes. For each case, US signs were reviewed according with 2018 FIGO guidelines and it was compared with surgical or histopathological findings. All the seven cases of PAS disorder treated in our centre during this period had a prenatal diagnosed. All women had a previous Caesarean birth and five had placenta previa. Regarding the US signs, myometrial thinning and loss of retroplacental clear space were described in all cases of PAS; vascular lacunae was present in six cases. Subplacental hypervascularisation was detected in four and uterovesical hypervascularisation and bridging vessels in three cases. Bladder wall interruption and placental bulge were observed only in two cases, both described as placenta percreta. Of the seven cases of PAS, three were considered placenta percreta according with US signs, but during surgery just two had the diagnose confirmed. Of the four cases with the diagnosis of placenta increta by US, two of them had surgical criteria of percreta. Regarding surgical approach, in all cases balloon occlusion catheters as placed in internal iliac and conservative management was possible in one case of placenta increta. There were no cases of maternal or neonatal death. In all cases, US signs of PAS disorder were present. Accurate prenatal diagnosis and multidisciplinary team approach have contributed to reduced adverse maternal and neonatal outcomes.