Placenta accreta spectrum: intraoperatory analysis for immediate tele-help.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Placenta accreta spectrum (PAS) is a severe obstetric complication with significant morbidity and mortality.
• A substantial proportion of PAS cases are not diagnosed prenatally, leading to unexpected intraoperative findings (IOF).
• Obstetricians may face complex PAS cases without adequate preparation or resources.

Purpose of the Study:

• To report a series of intraoperative finding (IOF) cases of placenta accreta spectrum (PAS).
• To analyze strategies for managing unexpected PAS IOF to improve patient outcomes.
• To highlight the importance of timely decision-making in complex obstetric emergencies.

Main Methods:

• Retrospective case series of four patients with intraoperative findings of PAS.
• Analysis of clinical management, including decisions to delay surgery or seek consultation.
• Evaluation of patient outcomes in relation to interventions and timing.

Main Results:

• Four cases of PAS IOF were identified in patients with prior cesarean sections and placenta previa/anterior.
• Prenatal ultrasound failed to detect PAS in these cases.
• Patients who had surgery postponed or received telesupport demonstrated better clinical outcomes.
• One patient with active bleeding required immediate intervention, precluding delay.

Conclusions:

• Intraoperative findings of PAS require careful management decisions.
• Delaying surgical intervention, when feasible, and utilizing telesupport can lead to improved outcomes.
• Effective management of PAS IOF is critical for patient safety and successful obstetric care.