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Placenta Accreta Spectrum: Diagnostic Challenges and Management Strategies.

Zlatko Kirovakov1, Angel Yordanov2, Eva Tsoneva3

  • 1Faculty for Public Health and Healthcare, Burgas State University Prof. Dr. Assen Zlatarov, 8010 Burgas, Bulgaria.

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Summary

Placenta Accreta Spectrum (PAS) is a severe pregnancy complication linked to uterine scarring, causing significant maternal risks. Early diagnosis and planned hysterectomy are key, though conservative options exist for select cases.

Keywords:
antenatal diagnosiscesarean hysterectomyconservative managementmultidisciplinary careobstetric hemorrhageplacenta previa

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Reproductive Health

Background:

  • Placenta Accreta Spectrum (PAS) presents a significant threat to maternal health, associated with high rates of morbidity and mortality.
  • Impaired decidualization in uterine scars is the primary cause of abnormal placental adherence or invasion.
  • Existing evidence highlights the need for updated management strategies and diagnostic criteria.

Purpose of the Study:

  • To provide a comprehensive review of the etiology, pathophysiology, diagnosis, and management of Placenta Accreta Spectrum (PAS).
  • To emphasize clinical implications and identify current gaps in evidence for PAS management.
  • To update healthcare providers on the latest approaches to high-risk pregnancies involving PAS.

Main Methods:

  • Narrative review of existing literature on Placenta Accreta Spectrum (PAS).
  • Analysis of diagnostic approaches, including pathological and imaging findings.
  • Evaluation of current management strategies, encompassing surgical and conservative options.

Main Results:

  • PAS significantly increases maternal morbidity and mortality, with rates nearing 7%.
  • Early antenatal identification through characteristic findings is crucial for optimal outcomes.
  • Planned cesarean hysterectomy is the recommended treatment for most PAS cases, while conservative approaches require careful selection and specialized management.

Conclusions:

  • Effective management of PAS hinges on early diagnosis and a multidisciplinary approach.
  • Standardized diagnostic criteria and prospective evaluation of conservative strategies are needed.
  • Improved access to specialized centers and expertise is essential for advancing PAS care and improving patient outcomes.