In recent years, there has been a significant rise in cases of placenta accreta spectrum, a group of life-threatening placental disorders that can arise during childbirth. Early detection plays a crucial role in facilitating meticulous delivery planning, ultimately leading to a reduction in mortality and morbidity rates and improved overall outcomes. Although third-trimester ultrasound has traditionally been the primary method for prenatal screening for placenta accreta spectrum, it often falls short in identifying cases or diagnosis is too late for optimal delivery planning. Emerging evidence has highlighted the option of early detection of placenta accreta spectrum indicators during the first trimester of pregnancy. This comprehensive review delves into our current knowledge of sonographic assessment of the uterine cervicoisthmic complex in the first trimester, examining the location and appearance of cesarean scars and exploring first-trimester screening strategies, ultimately paving the way for improved maternal and neonatal outcomes.
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| http://dx.doi.org/10.1016/j.ajogmf.2024.101329 | DOI Listing |
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The Role of Interventional Radiology in Managing Placenta Accreta Spectrum Disorder.
Clin Obstet Gynecol
January 2025
Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
Interventional Radiology (IR) can be a crucial player in managing placenta accrete spectrum disorder (PAS), offering minimally invasive angiographic techniques that can prevent or control hemorrhage and preserve fertility. These include prophylactic balloon occlusion of the aorta or iliac arteries, preoperative catheter placement in the iliac or uterine arteries for subsequent embolization, or pre-emptive arterial embolization preceding hysterotomy and delivery. This review provides obstetricians with an overview of IR's role in the management of PAS by describing specific endovascular techniques; existing outcomes data; and considerations for protocol development, preoperative planning, and intraoperative dynamics for when IR assists with PAS cases.
View Article and Find Full Text PDFSingleton term pregnancies resulting from frozen-thawed embryo transfer in hormone replacement cycles increase the risk of aberrant placentation, including velamentous umbilical cord insertion.
Arch Gynecol Obstet
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Kubonoya Women's Hospital, 2-2-12 Chuou, Kashiwa City, Chiba, 277-0023, Japan.
Purpose: The number of frozen-thawed embryo transfers (FETs) has recently increased, and FET must be completed in the ovulatory (NC-FET) or programmed hormone replacement cycle (HRC-FET). However, the relationship between FET and abnormal placentation is unclear. This study aimed to determine whether the two distinct endometrial preparation protocols affect the incidence of several pathologic conditions caused by abnormal placentation, such as placenta with velamentous umbilical cord insertion (VCI), hypertensive disorders of pregnancy (HDP), and placenta accreta spectrum (PAS).
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AJOG Glob Rep
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Tunis Medical Faculty, Tunis Centre for Maternity and Neonatal Care, Tunis El Manar University, Tunis, Tunisia (Abouda, Aloui, Azouz, Marzouk, Frikha, Hammami, Minjli, Hentati, Khila, Chanoufi, Karoui, and Hayen).
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Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue, Chengdu, Sichuan, 610091, China.
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Beyond the Scalpel: Unravelling the Anaesthetic Maze in Elective C-Section for Placenta Accreta Spectrum.
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Department of Anaesthesia, University College London Hospital NHS Foundation Trust, London, UK.
Placenta accreta spectrum (PAS) disorders pose significant challenges in the anaesthetic management of elective caesarean section. This article explores the anaesthetic considerations for patients with PAS focusing on the optimal techniques to ensure maternal safety and surgical success. The analysis examines the advantages and disadvantages of general anaesthesia, neuraxial anaesthesia, and combined techniques to inform considerations of anaesthetic management in this high-risk population.
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