A Review of Conservative Surgical Approaches for Managing Placenta Accreta Spectrum

TL;DR

This paper reviews conservative surgical methods for managing placenta accreta spectrum, aiming to reduce blood loss and preserve the uterus.

Contribution

The paper provides a comprehensive review of emerging conservative surgical approaches for placenta accreta spectrum.

Findings

Conservative approaches include leaving the placenta for autolysis or delayed hysterectomy.

Intraoperative arterial occlusion is another method to reduce blood loss and preserve the uterus.

Multidisciplinary teams are crucial for successful surgical management of PAS.

Abstract

The placenta accreta spectrum (PAS) was previously called the morbidly adherent placenta. It involves a range of pathological adherence of the placenta, including placenta increta, placenta percreta and placenta accreta, depending on the depth of invasion of anchoring villi into the myometrium and beyond. This spectrum of disorder is becoming a frequently encountered problem as a consequence of rising caesarean rates all over the world. Hysterectomy during caesarean delivery (CD) has been the conventional management of PAS. However, associated complications have prompted conservative surgery at the first sitting, with or without interventional radiology. The aim is to reduce blood loss and conserve the uterus if possible. It was decided to review the available literature on this emerging topic. Using PubMed and Google Scholar, our search focused on articles published from 2004 onwards, utilizing search terms "Placenta Accreta Spectrum” OR "Adherent Placenta" and "Caesarean Delivery". The selection for review adhered to specified inclusion/exclusion criteria and finally focused on 50 articles. It was found that published work includes the following conservative approaches: first, to leave the placenta expecting autolysis and resolution; second, to leave the placenta with the intention of a delayed hysterectomy; and third, to resort to an intraoperative arterial occlusion and follow-up. Though the primary objective of reducing blood loss at initial surgery is usually achieved, the success of uterine preservation differs. The availability of a multidisciplinary team for the surgical management of PAS is an important factor to consider. Limiting the extent of surgery at the time of CD, combined with or without arterial embolization/ballooning/ligation, reduces blood loss and limits morbidity with the potential to preserve the uterus.

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