In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta , thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
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http://dx.doi.org/10.1080/08941939.2019.1623956 | DOI Listing |
J Magn Reson Imaging
January 2025
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Background: Bladder injury during cesarean delivery (CD) in pregnant women with severe placenta accreta spectrum (PAS) disorders mostly occurs in the dissection of vesico-uterine space. Placental MRI may help to assess the risk of bladder injury preoperatively.
Purpose: To identify the high-risk MRI signs of bladder injury during CD in women with severe PAS.
BMC Pregnancy Childbirth
January 2025
Department of Obstetrics and Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, 151001, India.
Background: Placenta accreta spectrum (PAS) disorder is a fatal condition responsible for obstetric haemorrhage, which contributes to increased feto-maternal morbidity and mortality. The main contributing factor is a scarred uterus, often from a previous cesarean delivery, myomectomy, or uterine instrumentation. The occurrence of PAS in an unscarred uterus is extremely rare, with only anecdotal cases reported so far in the literature.
View Article and Find Full Text PDFCureus
December 2024
Obstetrics and Gynaecology, Centro Hospitalar de Leiria, Unidade Local de Saúde da Região de Leiria, Leiria, PRT.
Placenta accreta represents a spectrum of adherent placental anomalies and is an atypical invasion of the placenta. The major predisposing factor is a prior cesarean delivery. Placenta previa is considered an additional risk factor.
View Article and Find Full Text PDFInt J Mol Sci
December 2024
National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician Kulakov V.I., 117997 Moscow, Russia.
Despite the increasing number of placenta accreta spectrum (PAS) cases in recent years, its impact on neonatal outcomes and respiratory morbidity, as well as the underlying pathogenetic mechanism, has not yet been extensively studied. Moreover, no study has yet demonstrated the effectiveness of antenatal corticosteroid therapy (CT) for the prevention of respiratory distress syndrome (RDS) in newborns of mothers with PAS at the molecular level. In this regard, microRNA (miRNA) profiling by small RNA deep sequencing and quantitative real-time PCR was performed on 160 blood plasma samples from preterm infants (gestational age: 33-36 weeks) and their mothers who had been diagnosed with or without PAS depending on the timing of the antenatal RDS prophylaxis.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. Electronic address:
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and mitigating it is a global health priority. In this review, we discuss the measurement, assessment, and treatment of PPH. We review different methods of quantifying blood loss, including gravimetry, calibrated drapes and canisters, and colorimetric techniques.
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