Strategies for streamlining uterine topographic classification in placenta accreta spectrum

Area of Science:

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

Background:

• Effective management of placenta accreta spectrum (PAS), uterine dehiscence, and anterior placenta previa necessitates deep knowledge of uterine topography and vascular anatomy.
• This expertise is often gained through extensive experience, posing a challenge for clinicians in referral centers with infrequent cases.

Purpose of the Study:

• To present a simplified, practical framework for clinicians managing placenta accreta spectrum (PAS) disorders.
• To provide strategies for overcoming challenges in individualized, topography-based surgical management of PAS.
• To enhance surgical decision-making, promoting uterine preservation when feasible and timely hysterectomy when necessary.

Main Methods:

• Development of a practical framework integrating uterine topography and vascular anatomy.
• Emphasis on recognizing anatomical patterns and anticipating complications based on topographical classification.
• Tailoring vascular control strategies to specific clinical scenarios.

Main Results:

• The framework supports confident surgical approaches, including uterine-sparing techniques.
• It aids in timely decisions regarding hysterectomy for complex or rare PAS presentations.
• Anticipating complications based on topographical type improves surgical planning.

Conclusions:

• A topography-based approach enhances surgical management of PAS, anterior placenta previa, and uterine dehiscence.
• Collaboration, seeking support, and utilizing telemedicine are crucial for managing rare and complex cases.
• This framework empowers clinicians to navigate PAS management effectively, balancing conservative and definitive surgical options.