Download PDF
CC BY-NC-ND 4.0 · Surg J (N Y) 2021; 07(S 01): S2-S6
DOI: 10.1055/s-0040-1722240
Precision Surgery in Obstetrics and Gynecology

Expectant Management of Placenta Accreta Spectrum Disorders

Eiji Kondoh
1   Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Placenta accreta spectrum (PAS) disorder is a potentially life-threatening complication. The incidence of PAS has increased over the past few decades, mainly due to the increased cesarean section rate. While cesarean hysterectomy remains the most standard treatment for the management of PAS, expectant management is becoming increasingly prevalent to avoid serious maternal morbidity and maintain future fertility. Expectant management is defined as leaving the placenta either partially or fully in situ, and waiting for its spontaneous resorption or expulsion. The success rate of expectant management is high, but intraoperative uncontrolled hemorrhage results in hysterectomy. Moreover, some individuals fail expectant management and require delayed hysterectomy due to complications such as secondary postpartum hemorrhage, sepsis, uterine necrosis, and vesicouterine fistula. As a result of the very limited data currently available, there is no consensus on the optimal strategy for the expectant management of PAS. However, it is clear that a multidisciplinary team approach in tertiary centers is essential for women with PAS. In addition, meticulous preparation is the key to successful expectant management. Here, we describe a surgical strategy designed to reduce perioperative blood loss, which is a minimum requirement to ensure maternal safety. This article also addresses practical issues in expectant management of PAS, based on the published literature and our own experience.

Keywords

balloon tamponade - expectant management - leaving the placenta in situ - placenta accreta spectrum - uncontrolled hemorrhage


Publication History

Article published online:
03 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet 2018; 140 (03) 265-273
    CrossrefPubMedGoogle Scholar
  • 2 Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta accreta spectrum. Am J Obstet Gynecol 2018; 219 (06) B2-B16
    CrossrefPubMedGoogle Scholar
  • 3 Kondoh E, Kawasaki K, Chigusa Y. et al. Optimal strategies for conservative management of placenta accreta: a review of the literature. Hypertens Res Pregnancy 2015; 3: 19-27
    CrossrefPubMedGoogle Scholar
  • 4 Kondoh E, Kawasaki K, Kawamura A, Ueda A, Fujita K, Konishi I. Successful management of intraoperative hemorrhage from placenta previa accreta: intrauterine tamponade balloons brought out through the abdominal wall. J Matern Fetal Neonatal Med 2014; 27 (03) 309-311
    CrossrefPubMedGoogle Scholar
  • 5 Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet 2018; 140 (03) 291-298
    CrossrefPubMedGoogle Scholar
  • 6 Sentilhes L, Ambroselli C, Kayem G. et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010; 115 (03) 526-534
    CrossrefPubMedGoogle Scholar
  • 7 Imai S, Kondoh E, Kawasaki K. et al. Placental blood flow disappears coincident with a fall in human chorionic gonadotropin to undetectable levels in conservative management of placenta accreta. Eur J Obstet Gynecol Reprod Biol 2014; 180: 199-201
    CrossrefPubMedGoogle Scholar
  • 8 Ueda Y, Kondoh E, Kakui K. et al. Serial magnetic resonance imaging of placenta percreta with bladder involvement during pregnancy and postpartum: a case report. J Obstet Gynaecol Res 2013; 39 (01) 359-363
    CrossrefPubMedGoogle Scholar