Placenta accreta spectrum disorder management: literature review and authors experience

Abstract

Placenta accreta spectrum disorder (PSD) is a rare complication of pregnancy with extremely severe consequences, including hysterectomy, massive bleeding, and fetal asphyxia. The frequency of such disorders has been increasing over the past decades all over the world, which is primarily due to the higher frequency of cesarean sections and comorbidities, the older age of pregnant women. The experience of doctors worldwide in the treatment of patients with RSPA is limited and is limited to published descriptions of clinical cases or clinical case series.

The aim of this review is to analyze evidence-based medicine data on surgical treatment and intensive care approaches for patients with RSPA in the world, as well as to present our own experience of surgical treatment and intensive care for patients with placenta accreta (placenta increta).

According to the results of the literature review, the key points in the management of patients with RSPA are the strategies of adherence to Patient blood management: prevention and treatment of anemia in pregnant women, preparation of the blood bank for a possible massive hemotransfusion, adherence to protocols for the management of massive obstetric bleeding, in particular, the use of tranexamic acid and early hemotransfusion, objective calculation of blood loss, etc. The surgical technique of treatment is mainly hysterectomy with minimal blood loss (after suturing the incision on the uterus), however, in women who wish to preserve fertility, organ-sparing surgery using autohemotransfusion may be chosen in individual cases.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.