Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists

Area of Science:

• Obstetrics and Gynecology
• Surgical Oncology
• Maternal-Fetal Medicine

Background:

• Placenta accreta spectrum (PAS) disorders are increasingly prevalent, linked to cesarean section rates.
• PAS poses significant risks for severe postpartum hemorrhage, maternal mortality, and organ damage.
• Management is complex due to anatomical distortion and neovascularization during pregnancy.

Purpose of the Study:

• To provide recommendations for gynecologic oncologists managing placenta accreta spectrum.
• To emphasize the proactive involvement of gynecologic oncologists in PAS care.
• To guide the development of clinical protocols and patient counseling for PAS.

Main Methods:

• Review of current guidelines and literature on placenta accreta spectrum management.
• Highlighting the role of gynecologic oncologists in complex pelvic surgery.
• Discussion of surgical strategies, including hemostasis and injury prevention.

Main Results:

• Centers of Excellence for PAS require surgeons experienced in complex pelvic surgery.
• Gynecologic oncologists are vital due to their expertise in challenging pelvic dissections.
• A systematic approach is crucial for preventing urologic injuries and managing hemorrhage.

Conclusions:

• Gynecologic oncologists are essential for the multidisciplinary management of PAS.
• Proactive involvement, from protocol development to pre-operative counseling, is superior to a 'call if needed' approach.
• Optimizing PAS care requires collaboration and specialized surgical skills.