Background: Placenta accreta spectrum (PAS) disorder refers to
pathologic adherence of the placenta and presents multiple perinatal challenges,
accounting for between 30–50% of emergency peripartum hysterectomies. Accurate
prenatal diagnosis allows multidisciplinary management and delivery at centres
with experience and has been shown to improve perinatal outcomes. This study aims
to analyse the results of implementing different strategies across the years on
the diagnosis and management of PAS in a tertiary Australian hospital (Liverpool
Hospital) including: the use of magnetic resonance imaging (MRI) and the benefits
of the use of iliac artery balloons and ureteric stents. Secondary objectives
include analysis of the risk factors and outcomes. Methods:
Retrospective case series of 34 pregnancies complicated by PAS disorders,
diagnosed between 2004 and 2020, and delivered at Liverpool Hospital. Descriptive
and analytic study (with a significance level of p 0.05),
approved by the Research Ethics and Governance Information System.
Results: The incidence of PAS was 0.6 per 1000 deliveries. The typical
risk factors (previous uterine surgeries and placenta praevia) were present in
79% of the cases. MRI was used in 39% of the cases (when ultrasound was
inconclusive or placenta posterior) and was only inconclusive in 1 case. In
total, 32% required emergency delivery due to haemorrhage or preterm labor. The
overall complications rate was 32%. Ureteric stents were used in 44% of the
cases and there were no ureteric injuries. The use of iliac balloons reduced the
total blood loss (2.5 L compared to 2.8 L), however this difference was not
statistically significant (p = 0.21). Conclusions: The prenatal
diagnosis of PAS is essential to allow optimal perinatal management of these
cases. The use of MRI appears helpful when ultrasound is inconclusive. In our
study, the use of iliac balloons reduced blood loss, although this was not
statistically significant, and ureteric stents appeared useful to avoid ureteric
injury in the most complex cases, although the sample is very small. We hope that
our study will help us improving our clinical practice.
