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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(09): 713-723
DOI: 10.1055/s-0041-1736371
Febrasgo Position Statement

Management of placenta accreta spectrum

Number 9 - September 2021
Álvaro Luiz Lage Alves 
1   Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
,
Lucas Barbosa da Silva 
2   Hospital Sofia Feldman, Belo Horizonte, MG, Brazil
,
Fabrício da Silva Costa 
3   Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
,
Guilherme de Castro Rezende 
4   Faculdade de Saúde e Ecologia Humana, Belo Horizonte, MG, Brazil
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Key points

  • Reducing caesarean section rates is the main preventive measure for the placenta accreta spectrum (PAS).

  • Early diagnosis of PAS, adequate planning of surgical intervention and the use of effective techniques in intraoperative hemorrhagic control offer greater possibility of preserving life, the uterus and fertility.

  • The treatment of PAS should be defined by a preoperative plan and performed in a tertiary service by a multidisciplinary experienced team.

  • Maternal morbidity and mortality are lower among pregnant women with PAS treated in specialized centers.

  • Ultrasound is the method of choice for the diagnosis of PAS, and standardized descriptors in grayscale, color Doppler and, if available, 3D power Doppler should be used.

  • The most common ultrasound findings of the PAS are disruption of the interface between the uterine serosa and bladder walls and multiple intraplacental lacunae.

  • Placental non-removal should be routine in the surgical treatment of PAS.

  • Knowledge of the anatomical details and arterial components of the S1 and S2 genital vascular regions are of paramount importance for the surgical management of PAS.

The National Specialty Commission in Obstetric Emergency and the National Specialty Commission on Ultrasonography in Gynecology of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.




Publication History

Article published online:
20 October 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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