Placenta accreta spectrum disorders clinical practice guidelines: A systematic review

Area of Science:

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

Background:

• Placenta accreta spectrum (PAS) disorders pose significant risks during pregnancy, necessitating clear clinical practice guidelines (CPGs).
• Evaluating the quality and consistency of existing CPGs is crucial for optimizing patient care and management strategies.

Approach:

• A systematic literature search was conducted across major databases (MEDLINE, Embase, Scopus, Web of Science).
• Nine clinical practice guidelines on PAS management were assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
• Key management aspects evaluated included risk factors, prenatal diagnosis, interventional radiology, ureteral stenting, and surgical approaches.

Key Points:

• Most CPGs (over 60% quality score) addressed risk factors like placenta previa and prior uterine surgery.
• Guidelines recommended ultrasound in the second/third trimester (55.6%) and Cesarean delivery between 34-37 weeks (88.9%).
• Consensus was lacking on the indications for Magnetic Resonance Imaging (MRI), interventional radiology, and ureteral stenting.

Conclusions:

• Published CPGs for PAS management are generally of good quality, with consensus on risk stratification, diagnosis, and delivery timing.
• Discrepancies exist regarding the role of MRI, interventional radiology, and ureteral stenting in PAS management.
• Further standardization is needed for specific diagnostic and interventional aspects of PAS care.