A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum
van Beekhuizen HJ., Stefanovic V., Schwickert A., Henrich W., Fox KA., MHallem Gziri M., Sentilhes L., Gronbeck L., Chantraine F., Morel O., Bertholdt C., Braun T., Rijken MJ., Duvekot JJ., Calda P., Chalubinski KM., Collins S., Martinelli P., Morlando M., Nonnenmacher A., Paavonen J., Pateisky P., Petit P., Ropacka M., Tikkanen M., Tutschek B., Weichert A., Weizsäcker KV.
Introduction: Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort. Material and methods: Data from women in 15 referral centers of the International Society of PAS (IS-PAS) were analyzed and correlated with the clinical classification of the IS-PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10. Results: In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150-20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P