Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Outcomes

Background:

• Placenta accreta spectrum (PAS) is a high-risk pregnancy complication.
• Distinguishing between expected (ePAS) and unexpected (uPAS) cases is crucial for management.
• Multidisciplinary centers play a vital role in managing complex PAS cases.

Purpose of the Study:

• To compare maternal and neonatal outcomes in expected (ePAS) versus unexpected (uPAS) pathologically proven placenta accreta spectrum cases.
• To evaluate the impact of antenatal diagnosis on PAS-related morbidity.
• To assess the effectiveness of a single multidisciplinary center approach to PAS management.

Main Methods:

• Retrospective cohort study of 92 histopathologically confirmed PAS cases (January 2011-September 2021).
• Cases were categorized as expected PAS (ePAS) if diagnosed antenatally, or unexpected PAS (uPAS) if diagnosed at delivery.
• Maternal and neonatal outcomes were compared between ePAS and uPAS groups.

Main Results:

• Unexpected PAS (uPAS) constituted 38% of cases.
• Higher rates of placenta previa and percreta were observed in the ePAS group.
• The uPAS group required significantly more packed red blood cell transfusions, despite similar intraoperative complication rates and adverse neonatal outcomes.
• Preterm delivery was more frequent in the ePAS group.

Conclusions:

• Antenatal diagnosis of PAS (ePAS) is associated with lower maternal hemorrhagic morbidity compared to unexpected cases (uPAS), even with higher rates of invasive placentation.
• Increasing antenatal diagnosis rates is essential for reducing maternal morbidity in PAS.
• A multidisciplinary approach is effective in managing PAS spectrum disorders.