Placenta Accreta Spectrum Care in Middle-Resource Settings.

Management of the placenta accreta spectrum (PAS) in resource-limited settings poses significant challenges. Traditional approaches, which often involve hysterectomy and extensive technology in all the patients are being replaced by individualized treatment plans considering each patient's specific clinical situation, available resources, and team expertise. Using ultrasonographic and surgical staging based on PAS topographic classification can help design tailored surgical plans and optimize resource use.

Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage.

The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids).

Telemedicine ultrasound assessment for placenta accreta spectrum: Utility and interobserver reliability of asynchronous remote imaging review.

Objective: Management of patients with placenta accreta spectrum (PAS) by trained multidisciplinary teams is associated with improved outcomes. Ultrasound can predict intraoperative risks, but expert ultrasound imaging of PAS is often limited. Telemedicine is used increasingly in obstetrics, permitting expert consultation when essential resources are not available locally.

[Uterine conservative treatment for placenta accreta : new standard?].

Placenta accreta spectrum (PAS) is among the most dangerous obstetric conditions due to elevated risk of massive hemorrhage. Ultrasound is PAS's preferred screening method. This article -introduces the new topographic classification of PAS, allowing for treatment selection, whether radical or conservative.

Usefulness of low-cost simulation models to learning surgical techniques for placenta accreta spectrum: An observational educational study.

Objective: To evaluate the utility of low-cost simulation models to teach surgical techniques for placenta accreta spectrum (PAS), included in a multimodal education workshop for PAS.

Methods: This was an observational, survey-based study. Participants were surveyed before and after the use of low-fidelity mannequins to simulate two surgical techniques for PAS (one-step conservative surgery [OSCS] and modified subtotal hysterectomy [MSTH]), within a multimodal educational workshop.

Advanced repair of recurrent and low-large hysterotomy defects using a myometrial glide flap.

Background: The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the dehiscent area, eliminates associated intraluminal fibrosis, and establishes a vascularized anterior wall by creating a sliding myometrial flap.

Objective: Propose a comprehensive surgical repair for recurrent and large low hysterotomy defects in women seeking pregnancy or recurrent spotting.

Study Design: A retrospective cohort analysis included 54 patients aged 25-41 with recurrent large cesarean scar defects treated at Otamendi, CEMIC, and Valle de Lili hospitals.

One-step conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial.

Background: Placenta accreta spectrum is a serious condition associated with significant maternal morbidity and even mortality. The recommended treatment is hysterectomy. An alternative is 1-step conservative surgery, which involves the en bloc resection of the myometrium affected by placenta accreta spectrum along with the placenta, followed by uterine reconstruction.

Management of placenta accreta spectrum in low- and middle-income countries.

Placenta accreta spectrum (PAS) can be associated massive intra- and post-operative hemorrhage which when not controlled can lead to maternal death. Important advances have occurred in understanding the pathophysiology and therapeutic options for this condition. The prevalence of PAS at birth is direct association with the cesarean delivery (CD) rate in the corresponding population and is increasing worldwide.

Anesthesia and postpartum pain management for placenta accreta spectrum: The patient perspective and recommendations for care.

Objective: Placenta accreta spectrum (PAS) is a high-risk complication of pregnancy, which often requires complex surgical intervention. There is limited literature on the patient experience during the perioperative period and postpartum pain management for PAS. Therefore, this study aims to explore the patient perspective of anesthesia care.

Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective.

Objective: To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS).

Methods: This descriptive survey study was carried out over a 6-week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate.

Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis.

Objective: To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS).

Methods: MEDLINE, EMBASE and the Cochrane databases were searched electronically up to 1 November 2022. Studies reporting on the urological outcome of women undergoing Cesarean section for PAS were included.

Placenta accreta spectrum with severe morbidity: fibrosis associated with cervical-trigonal invasion.

Objective: Describe the clinical-surgical results of patients with PAS in the low-posterior cervical-trigonal space associated with fibrosis (PAS type 4) compared with PAS types in other locations (Types 1, upper bladder, 2 in upper parametrium) and in particular with PAS type 3, corresponding to dissectible cervical-trigonal invasion. The clinical-surgical results of using a standard hysterectomy were analyzed with a modified subtotal hysterectomy (MSTH) in patients with PAS type 4.

Material And Methods: A descriptive, retrospective, multicenter study included 337 patients of PAS; thirty-two corresponding to PAS type 4, from three PAS reference hospitals, CEMIC, Buenos Aires, Argentina, Fundación Valle de Lili, Cali, Colombia, and Dr.

Anatomical basis for the uterine vascular control: implications in training, knowledge, and outcomes.

The efficiency of uterine vascular control depends on the precise management of its arterial pedicles and anastomotic network. Although all specialists know the uterine and ovarian arteries, only a few are familiar with the anatomy of the inferior supply system and the connections of the pelvic vessels. For this reason, specific proven inefficient hemostatic procedures are still used worldwide.

Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location.

Objective: To demonstrate the surgical and morbidity differences between upper and lower parametrial placenta invasion (PPI).

Materials And Methods: Forty patients with placenta accreta spectrum (PAS) into the parametrium underwent surgery between 2015 and 2020. Based on the peritoneal reflection, the study compared two types of parametrial placental invasion (PPI), upper or lower.

Placenta accreta spectrum disorders clinical practice guidelines: A systematic review.

Objectives: To objectively assess the quality of the published clinical practice guidelines (CPGs) on the management of pregnancies complicated by placenta accreta spectrum (PAS)disorders.

Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to the management of pregnancies with suspected PAS disorders were evaluated: risk factors for PAS, prenatal diagnosis, role of interventional radiology and ureteral stenting, and optimal surgical management.

Comprehensive surgical staging for placenta accreta spectrum.

Objective: To analyze how precise the surgical staging is after prenatal diagnosis of patients with placenta accreta spectrum (PAS).

Material And Methods: This was a retrospective cohort study that included 622 women diagnosed with placenta accreta spectrum who underwent surgery between 1 January 2000, and 1 January 2020, in public, private, and university hospitals in Buenos Aires, Argentina. Prenatal diagnosis included abdominal and transvaginal ultrasounds and T2-weighted MRI scans.