Placenta accreta spectrum (PAS), an obstetric emergency associated with significant maternal morbidity and mortality, has increasingly become a global challenge with the rising trend of cesarean deliveries. This book provides a comprehensive review of basic science-related to PAS, discusses modern practice in diagnosis and classification of PAS disorders, and appraise current recommendations on PAS management in view of recent studies, guidelines, and expert opinions.
In the last few years, there have been many new updates to practice guidelines including ACOG, RCOG, and FIGO guidelines in addition to several new studies, some of which were unusually multicenter and of large sample size, that are eligible to make major changes in our PAS practice. In addition, the book aims at providing more comprehensive review of all aspects related to PAS from experts, including topics that are deficient in similar books e.g., vascular anatomy, risk reduction, adjuvant treatments.The book provides a single source that provides academic knowledge for researchers and investigators, and clinical guidance to best practice and recent updates in management of women with PAS.
Author(s): Sherif A. Shazly, Ahmed A. Nassr
Publisher: Springer
Year: 2022
Language: English
Pages: 200
City: Cham
Contents
Contributors
Chapter 1: History of Placenta Accreta Spectrum
References
Chapter 2: Epidemiology of Placenta Accreta Spectrum: A Comprehensive Review of Current Evidence
Introduction
Definition and Terminology
Incidence and Increasing Trend Globally
Morbidity and Mortality
Risk Factors
Caesarean Section
Placenta Praevia
Advanced Maternal Age
Assisted Reproductive Technologies
Previous Gynaecological History
Previous Obstetric History
Management
Conclusion
References
Chapter 3: Pathogenesis of Placenta Accreta Spectrum
References
Chapter 4: Anatomy of Placenta Accreta Spectrum
General Overview
Pelvic Spaces or Areas
Vesicouterine Space (VUS)
Paracervical Space
Prevesical Space
Paravesical Space
Pararectal Space
Parametrial Space
Vascular Anatomy
Proximal Vascular Control
Uterine Vascular Areas
Anterior Placenta Invasion
Posterior Upper Bladder
Posterior Lower Bladder
Lateral Invasion: The Parametrium
Posterior Invasion
Uterine Blood Supply
Anatomy Learning for Surgeons
Summary
References
Chapter 5: Classification of Placenta Accreta Spectrum
Introduction
Clinicopathology Classification
Vascular Classification
Placental-Type Invasion
Type 1
Type 2
Type 3
Type 4
Type 5
Placental Mapping for Prenatal Diagnosis of Placenta Accreta Spectrum Grading
Conclusion
References
Chapter 6: Diagnosis of Placenta Accreta Spectrum: Clinical and Radiological Diagnosis of Placenta Accreta Spectrum and the Ability of Sonographic and MRI Findings to Predict Definitive Diagnosis
The Importance of Antenatal Diagnosis of Placenta Accreta Spectrum
Antenatal Diagnosis: Role of Different Imaging Modalities
First Trimester Imaging
Second or Third Trimester Ultrasound Evaluation
MRI Evaluation
Special Considerations
References
Chapter 7: Definitive Management of Placenta Accreta Spectrum
Introduction
Preoperative Preparation
Anaesthesia
Surgical Management of an Antenatally Suspected Case
Surgical Management of an Unexpected Case
Postoperative Considerations
Surgical Morbidity
Psychological Impact
Conclusion
References
Chapter 8: Conservative Management of Placenta Accreta Spectrum
Definition
Risk Factors
Clinical Presentation and Diagnosis
Management
Timing of Delivery
Cesarean Delivery and Hysterectomy
Conservative Management
Follow-Up After Conservative Management
Long-Term Considerations
References
Chapter 9: Adjunctive Treatment of Placenta Accreta Spectrum
Introduction
Surgical Control of Bleeding
Uterine Artery Embolization
Internal Iliac Artery Ligation
Endovascular Balloon Occlusion of the Pelvic Circulation
Uterine Compression Sutures
Use of Tranexamic Acid
Investigational Therapies
High-Intensity Focused Ultrasound
Methotrexate
Conclusions
References
Chapter 10: Prediction and Risk Reduction of Clinical Outcomes of Placenta Accreta Spectrum
Introduction
PAR-A (Placenta Accreta Risk–Antepartum) and PAR-P (Placenta Accreta Risk–Peripartum) Scores
Score Development
Score Components
Score Performance
Score Applicability
Disadvantages and Limitations
Conservative Management of PAS (CON-PAS) Score
Score Development
Score Components
Score Performance
Score Applicability
Disadvantages and Limitations
Conclusion
References
Chapter 11: Evidence-Based Management of Placenta Accreta Spectrum
Introduction
Evidence-Based Recommendations on Management of PAS
Antenatal Screening
Transfer of Care
Delivery Planning
Preoperative Preparation
Intraoperative Management
Postoperative Care
Barriers to Evidence-Based Practice: Why Does Global Practice Not Strictly Follow Guidelines?
Validity of Established Practice: Why Does Established Practice Not Steer Guidelines?
Conclusion
References
Chapter 12: Prevention of Placenta Accreta Spectrum Disorders
Primary Prevention of PAS
Restraining the Increase in the Number of CS, Especially in Primiparous
Orientation of Pregnant Women with a Scar on the Uterus After CS to Attempt Vaginal Delivery in the Absence of Other Indications for CS
Modifying Other PAS-Related Risk Factors
Placenta Previa (РР)
Previous Uterine Surgery
Advanced Maternal Age
Interpregnancy Interval
Smoking
CS Technique
Assisted Reproductive Technologies
Secondary Prevention of PAS
References
Chapter 13: Setting Up a Referral Center for Placenta Accreta Spectrum
Introduction
What Constitutes a PAS Center of Excellence?
A Quick Overview
Research
Conclusion
References
Chapter 14: Management of PAS in Low-Resource Settings
Introduction
Prenatal Diagnosis
Ultrasound Approach and Placenta Accreta Spectrum Markers
First-Trimester Evaluation
Second- and Third-Trimester Evaluation
Planning for Delivery
Where to Deliver?
When to Deliver?
Who Should Deliver?
MDT and Hospitalization
Surgical Management
Urologic Injury
Type of Incisions for Access
Blood Conservation Techniques
Surgical Methods
Conservative Techniques
Radical Management
Steps of Classical Hysterectomy
Intraoperative Considerations According to Recent Guidelines [1]
Planned Hysterectomy
Unexpected Placenta Accreta or Intraoperative Diagnosis
Postoperative Care
Anesthetic Management
Conservative Management
References
Chapter 15: Management of Placenta Accreta Spectrum in the Second Trimester
Introduction
Pathophysiology
Diagnosis
Management
Second-Trimester Termination
Scheduled Hysterotomy
Peripartum Hysterectomy
Leaving Placenta In Situ
Conclusion
References
Chapter 16: Long-Term Outcomes of Conservative Management of PAS: Long-Term Sequences and Impact on Future Pregnancies
Introduction
An Old, Long, but Meaningful Story
Definitions and Problems
Lines of Conservative Management [5]
Long-Term Complications
Intrauterine Synechiae
Impaired Fertility
Negative Impact on Subsequent Pregnancies (Fig. 16.1)
Possible Effect of Arterial Embolization {Sentilhes, 2010 #507}
Recurrence
Summary
References
