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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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  • References

  • 1 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol. 2017; 130 (04) e168-86 DOI: 10.1097/AOG.0000000000002351.
    CrossrefPubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: placenta accreta spectrum. Obstet Gynecol. 2018; 132 (06) e259-75 DOI: 10.1097/AOG.0000000000002983.
    CrossrefPubMedGoogle Scholar
  • 3 Irving FC, Hertig AT. A study of placenta accreta. Surg Gynecol Obstet. 1937; 64: 178-200
    PubMedGoogle Scholar
  • 4 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) 291-8 DOI: 10.1002/ijgo.12410.
    CrossrefPubMedGoogle Scholar
  • 5 Palacios-Jaraquemada JM. How to reduce the incidence of placenta accreta spectrum independently of the number of cesarean?. Matern Fetal Med. 2019; 1 (02) 68-9 DOI: 10.1097/FM9.0000000000000020.
    CrossrefPubMedGoogle Scholar
  • 6 Janiaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. et al. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018; 140 (03) 274-80 DOI: 10.1002/ijgo.12408.
    CrossrefPubMedGoogle Scholar
  • 7 Buca D, Liberati M, Calì G, Forlani F, Caisutti C, Flacco ME. et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 52 (03) 304-9 DOI: 10.1002/uog.19070.
    CrossrefPubMedGoogle Scholar
  • 8 D'Antonio F, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F. et al. First-trimester detection of abnormally invasive placenta in high- risk women: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 51 (02) 176-83 DOI: 10.1002/uog.18840.
    CrossrefPubMedGoogle Scholar
  • 9 Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI. et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG. 2016; 123 (08) 1348-55 DOI: 10.1111/1471-0528.13547.
    CrossrefPubMedGoogle Scholar
  • 10 Melcer Y, Jauniaux E, Maymon S, Tsviban A, Pekar-Zlotin M, Betser M. et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol. 2018; 218 (04) 443.e1-8 DOI: 10.1016/j.ajog.2018.01.017.
    CrossrefPubMedGoogle Scholar
  • 11 Bhide A, Sebire N, Abuhamad A, Acharya G, Silver R. Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol. 2017; 49 (05) 559-63 DOI: 10.1002/uog.17417.
    CrossrefPubMedGoogle Scholar
  • 12 Shih JC, Palacios Jaraquemada JM, Su YN, Shyu MK, Lin CH, Lin SY. et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol. 2009; 33 (02) 193-203 DOI: 10.1002/uog.6284.
    CrossrefPubMedGoogle Scholar
  • 13 Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol. 2000; 15 (01) 28-35 DOI: 10.1046/j.1469-0705.2000.00018.x.
    CrossrefPubMedGoogle Scholar
  • 14 Kilcoyne A, Shenoy-Bhangle AS, Roberts DJ, Sisodia RC, Gervais DA, Lee SI. MRI of placenta accreta, placenta increta, and placenta percreta: pearls and pitfalls. AJR Am J Roentgenol. 2017; 208 (01) 214-221 DOI: 10.2214/AJR.16.16281.
    CrossrefPubMedGoogle Scholar
  • 15 Familiari A, Liberati M, Lim P, Pagani G, Cali G, Buca D. et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018; 97 (05) 507-20 DOI: 10.1111/aogs.13258.
    CrossrefPubMedGoogle Scholar
  • 16 Einerson BD, Rodriguez CE, Kennedy AM, Woodward PJ, Donnelly MA, Silver RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol. 2018; 218 (06) 618.e1-7 DOI: 10.1016/j.ajog.2018.03.013.
    CrossrefPubMedGoogle Scholar
  • 17 Collins SL, Stevenson GN, Al-Khan A, Illsley NP, Impey L, Pappas L. et al. Three-dimensional power doppler ultrasonography for diagnosing abnormally invasive placenta and quantifying the risk. Obstet Gynecol. 2015; 126 (03) 645-53 DOI: 10.1097/AOG.0000000000000962.
    CrossrefPubMedGoogle Scholar
  • 18 Clark SL, Hankins GD. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol. 2012; 119 (02) 360-4 DOI: 10.1097/AOG.0b013e3182411907.
    CrossrefPubMedGoogle Scholar
  • 19 Palacios-Jaraquemada JM. Surgical anatomy. In: Palacios-Jaraquemada JM. Placental adhesive disorders. Berlin: De Gruyter; 2012. . p. 43-78
    CrossrefGoogle Scholar
  • 20 Palacios-Jaraquemada JM. Caesarean section in cases of placenta praevia and accreta. Best Pract Res Clin Obstet Gynaecol. 2013; 27 (02) 221-32 DOI: 10.1016/j.bpobgyn.2012.10.003.
    CrossrefPubMedGoogle Scholar
  • 21 Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P. et al. Evidence-based guidelines for management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta (IS-AIP). Am J Obstet Gynecol. 2019; 220 (06) 511-26 DOI: 10.1016/j.ajog.2019.02.054.
    CrossrefPubMedGoogle Scholar
  • 22 D'Antonio F, Iacovelli A, Liberati M, Leombroni M, Murgano D, Cali G. et al. Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019; 53 (06) 743-51 DOI: 10.1002/uog.20131.
    CrossrefPubMedGoogle Scholar
  • 23 Lilker SJ, Meyer RA, Downey KN, Macarthur AJ. Anesthetic considerations for placenta accreta. Int J Obstet Anesth. 2011; 20 (04) 288-92 DOI: 10.1016/j.ijoa.2011.06.001.
    CrossrefPubMedGoogle Scholar
  • 24 Matsubara S, Takahashi H, Baba Y. Handling aberrant vessels located in posterior bladder wall in surgery for abnormally invasive placenta: a non/less-touch technique. Arch Gynecol Obstet. 2017; 296 (05) 851-3 DOI: 10.1007/s00404-017-4498-2.
    CrossrefPubMedGoogle Scholar
  • 25 Pelosi 3rd MA, Pelosi MA. Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass. Obstet Gynecol. 1999; 93 (5 Pt 2): 830-3 DOI: 10.1016/s0029-7844(98)00426-8.
    CrossrefPubMedGoogle Scholar
  • 26 Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F. et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod. 2010; 25 (11) 2803-10 DOI: 10.1093/humrep/deq239.
    CrossrefPubMedGoogle Scholar
  • 27 Dedes I, Ziogas V. Circular isthmic-cervical sutures can be an alternative method to control peripartum haemorrhage during caesarean section for placenta praevia accreta. Arch Gynecol Obstet. 2008; 278 (06) 555-7 DOI: 10.1007/s00404-008-0646-z.
    CrossrefPubMedGoogle Scholar
  • 28 Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand. 2011; 90 (09) 1036-42 DOI: 10.1111/j.1600-0412.2011.01176.x.
    CrossrefPubMedGoogle Scholar
  • 29 Shazly SA, Badee AY, Ali MK. The use of multiple 8 compression suturing as a novel procedure to preserve fertility in patients with placenta accreta: case series. Aust N Z J Obstet Gynaecol. 2012; 52 (04) 395-9 DOI: 10.1111/j.1479-828X.2012.01449.x.
    CrossrefPubMedGoogle Scholar
  • 30 Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK. et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015; 212 (05) 561-8 DOI: 10.1016/j.ajog.2014.11.018.
    CrossrefPubMedGoogle Scholar
  • 31 Clausen C, Lönn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand. 2014; 93 (02) 138-43 DOI: 10.1111/aogs.12295.
    CrossrefPubMedGoogle Scholar
  • 32 Legendre G, Zoulovits FJ, Kinn J, Senthiles L, Fernandez H. Conservative management of placenta accreta: hysteroscopic resection of retained tissues. J Minim Invasive Gynecol. 2014; 21 (05) 910-3 DOI: 10.1016/j.jmig.2014.04.004.
    CrossrefPubMedGoogle Scholar
  • 33 Milne ME, Yazer MH, Waters JH. Red blood cell salvage during obstetric hemorrhage. Obstet Gynecol. 2015; 125 (04) 919-23 DOI: 10.1097/AOG.0000000000000729.
    CrossrefPubMedGoogle Scholar
  • 34 Shih JC, Liu KL, Shyu MK. Temporary balloon occlusion of the common iliac artery: a new approach to bleeding control during cesarean hysterectomy for placenta percreta. Am J Obstet Gynecol. 2005; 193 (05) 1756-8 DOI: 10.1016/j.ajog.2005.08.033.
    CrossrefPubMedGoogle Scholar
  • 35 Chou MM, Chen MJ, Su HW, Chan CW, Kung HF, Tseng JJ. et al. Vascular control by infrarenal aortic cross-clamping in placenta accreta spectrum disorders: description of technique. BJOG. 2021; 128 (06) 1030-4 DOI: 10.1111/1471-0528.16605.
    CrossrefPubMedGoogle Scholar
  • 36 Riley DP, Burgess RW. External abdominal aortic compression: a study of a resuscitation manoeuvre for postpartum haemorrhage. Anaesth Intensive Care. 1994; 22 (05) 571-5 DOI: 10.1177/0310057X9402200512.
    CrossrefPubMedGoogle Scholar
  • 37 Chitrit Y, Guillaumin D, Caubel P, Herrero R. Absense of flow velocity waveform changes in uterine arteries after bilateral internal iliac ligation. Am J Obstet Gynecol. 2000; 182 (03) 727-8 DOI: 10.1067/mob.2000.101533.
    CrossrefPubMedGoogle Scholar
  • 38 Palacios-Jaraquemada JM, Fiorillo A. Conservative approach in heavy postpartum hemorrhage associated with coagulopathy. Acta Obstet Gynecol Scand. 2010; 89 (09) 1222-5 DOI: 10.3109/00016349.2010.491524.
    CrossrefPubMedGoogle Scholar
  • 39 Shamshirzas AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW. et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary team. Am J Obstet Gynecol. 2015; 212 (02) 218.e1-9 DOI: 10.1016/j.ajog.2014.08.019.
    CrossrefPubMedGoogle Scholar
  • 40 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) 265-73 DOI: 10.1002/ijgo.12407.
    CrossrefPubMedGoogle Scholar