Management Options of Placenta Accreta Spectrum

Abstract

Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. Typically, the placenta detaches from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains attached. This can cause severe blood loss after delivery. It's also possible for the placenta to invade the muscles of the uterus (placenta increta) or grow through the uterine wall (placenta percreta). Placenta accreta is considered a high-risk pregnancy complication. If the condition is diagnosed during pregnancy, you'll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy).All treatments designed to prevent peripartum hysterectomy and its associated morbidity and consequences are referred to as "conservative management" of both abnormally adherent (placenta accreta) and invasive placenta (placenta increta and percreta). Four different primary methods of conservative management have been described in the international literature: (1) the extirpative technique (manual removal of the placenta); (2) leaving the placenta in situ or the expectant approach; (3) one-step conservative surgery (removal of the accreta area); and (4) the Triple-P procedure (suturing around the accreta area after resection). These methods have been used alone or in combination and in many cases with additional procedures such as those suggested by interventional radiology. In contrast to the extirpative technique, leaving the placenta in situ primarily aims to reduce the risks of severe maternal morbidity during cesarean delivery.