Surgical Techniques for the Management of Placenta Accreta Spectrum

Fady Khoury-Collado; J. M. Newton; Olga R. Brook; Daniela A. Carusi; Vineet K. Shrivastava; Brian A. Crosland; Karin A. Fox; Meena Khandelwal; Amer K. Karam; Kelly A. Bennett; Adam T. Sandlin; Scott A. Shainker; Brett D. Einerson; Michael A. Belfort; for the Pan-American Society for Placenta Accreta Spectrum

doi:10.1055/s-0043-1761636

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(09): 970-979
DOI: 10.1055/s-0043-1761636

PAS Series Article

Review Article

Surgical Techniques for the Management of Placenta Accreta Spectrum

Fady Khoury-Collado

¹Division of Gynecologic Oncology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York

,

J. M. Newton

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee

,

Olga R. Brook

³Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Daniela A. Carusi

⁴Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Vineet K. Shrivastava

⁵Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Memorial Care Miller Children's & Women's Hospital, University of California Irvine, Irvine, California

,

Brian A. Crosland

⁶Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon

,

Karin A. Fox

⁷Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

,

Meena Khandelwal

⁸Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey

,

Amer K. Karam

⁹Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California

,

Kelly A. Bennett

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee

,

Adam T. Sandlin

¹⁰Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas

,

Scott A. Shainker

¹¹Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Brett D. Einerson

¹²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

,

Michael A. Belfort

¹³Departments of Obstetrics and Gynecology, Surgery, Anesthesiology and Neurosurgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas

,

for the Pan-American Society for Placenta Accreta Spectrum

› Author Affiliations

Abstract

The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS. In this manuscript, we outline individual components of the procedure and provide suggested direction at key points of a cesarean hysterectomy in the setting of PAS.

Key Points

The surgical management of PAS requires careful planning and expertise.
Multidisciplinary team care for pregnancies complicated by PAS can decrease morbidity and mortality.
Careful surgical techniques can minimize risk of significant hemorrhage by avoiding pitfalls.

Keywords

placenta accreta spectrum - surgical treatment - cesarean hysterectomy

Full Text

References

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