Evidence-Based Perioperative Management of Placenta Accreta Spectrum Disorder

Area of Science:

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

Background:

• Placenta accreta spectrum (PAS) is a significant cause of severe maternal morbidity, including hemorrhage and hysterectomy.
• Effective management strategies are crucial due to PAS's disproportionate contribution to obstetric complications.

Purpose of the Study:

• To outline evidence-based surgical management strategies for Placenta Accreta Spectrum (PAS) disorder.
• To highlight best practices and experimental approaches for reducing morbidity in PAS cases.

Main Methods:

• Review of established and emerging surgical management principles for PAS.
• Emphasis on preoperative optimization, intraoperative care, and specific surgical techniques.

Main Results:

• Preoperative anemia management and intraoperative resuscitation with blood products are beneficial.
• Key surgical practices include multidisciplinary team planning, careful hysterotomy site selection, and intraoperative assessment of placental adherence.
• Experimental strategies like routine cystoscopy and endovascular embolization require further research.

Conclusions:

• Standard cesarean delivery tenets should be maintained, alongside PAS-specific surgical approaches.
• Multidisciplinary planning and experienced teams are vital for managing PAS to minimize maternal morbidity.