Guidelines for intraoperative-management of unexpected ‘‘placenta accreta spectrum’’

Abstract

There has been several fold increase in the rate of placenta accreta spectrum (PAS) paralleling the ever-increasing surge in the rate of cesarean deliveries worldwide. Delivery of PAS is associated with increased maternal morbidity and mortality primarily due to hemorrhagic catastrophes. Nonetheless, outcome could be optimized with prenatal diagnosis which permits planning elective delivery by a multidisciplinary team at specialized centers. In spite of the improvements in prenatal diagnosis, yet, a substantial proportion of these cases are first encountered during or after delivery. Unexpected PAS eventually presents minimal difficulty and can be dealt with safely in large specialized centers, albeit some possible logistic inconveniences. This encounter, however, could represent dangerous challenges in small hospitals and birthing centers with limited resources.In spite of its seriousness, there is paucity of guidelines concerned with the management of unexpected PAS, particularly in less than optimal setups. Having had operated on 350 cases of PAS in our three tertiary-care university hospitals, we, the representatives of the Lebanese Percreta Group, opted to provide some useful practical guidelines to obstetricians confronted with such unexpected yet dangerous challenges. © 2020 Lebanese Order of Physicians. All rights reserved.