Placenta Accreta Spectrum.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
01 Jul 2023
01 Jul 2023
Historique:
received:
16
11
2022
accepted:
08
02
2023
pmc-release:
01
07
2024
medline:
26
6
2023
pubmed:
8
6
2023
entrez:
8
6
2023
Statut:
ppublish
Résumé
Placenta accreta spectrum (PAS) is one of the most dangerous conditions in pregnancy and is increasing in frequency. The risk of life-threatening bleeding is present throughout pregnancy but is particularly high at the time of delivery. Although the exact cause is unknown, the result is clear: Severe PAS distorts the uterus and surrounding anatomy and transforms the pelvis into an extremely high-flow vascular state. Screening for risk factors and assessing placental location by antenatal ultrasonography are essential for timely diagnosis. Further evaluation and confirmation of PAS are best performed in referral centers with expertise in antenatal imaging and surgical management of PAS. In the United States, cesarean hysterectomy with the placenta left in situ after delivery of the fetus is the most common treatment for PAS, but even in experienced referral centers, this treatment is often morbid, resulting in prolonged surgery, intraoperative injury to the urinary tract, blood transfusion, and admission to the intensive care unit. Postsurgical complications include high rates of posttraumatic stress disorder, pelvic pain, decreased quality of life, and depression. Team-based, patient-centered, evidence-based care from diagnosis to full recovery is needed to optimally manage this potentially deadly disorder. In a field that has relied mainly on expert opinion, more research is needed to explore alternative treatments and adjunctive surgical approaches to reduce blood loss and postoperative complications.
Identifiants
pubmed: 37290094
doi: 10.1097/AOG.0000000000005229
pii: 00006250-202307000-00006
pmc: PMC10491415
mid: NIHMS1894145
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
31-50Subventions
Organisme : NICHD NIH HHS
ID : K23 HD106009
Pays : United States
Informations de copyright
Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Financial Disclosure Lisa C. Zuckerwise reports money was paid to her institution from Laborie Medical Technologies Corp for an ongoing clinical study unrelated to placenta accreta spectrum. She received payment from Gershon, Willoughby & Getz, LLC, and Huff, Powell & Bailey, LLC for legal expert consulting not related to placenta accreta spectrum. The other authors did not report any potential conflicts of interest.
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