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Is Conservative Management of Placenta Accreta Spectrum Disorders Practical in the United States?

  • Beth L. PINELES
    Correspondence
    Corresponding author: Beth L. Pineles, MD, PhD, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin, Suite MSB 3.262, Houston, TX 77030, 713-500-6421 office, 949-293-7915 mobile, 713-500-0799 fax
    Affiliations
    McGovern Medical School at The University of Texas Health Science Center at Houston Department of Obstetrics, Gynecology & Reproductive Sciences, Houston, Texas
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  • Baha M. SIBAI
    Affiliations
    McGovern Medical School at The University of Texas Health Science Center at Houston Department of Obstetrics, Gynecology & Reproductive Sciences, Houston, Texas
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  • Loïc SENTILHES
    Affiliations
    Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Published:September 12, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100749

      Abstract

      This commentary discusses the issues related to conservative management (also called leaving the placenta in situ or Intentional retention of the placenta) of placenta accreta spectrum disorders (PAS). Considerations related to PAS management in the United States (U.S.) are compared with France, where conservative management is a well-accepted management option. The history of PAS treatment is reviewed, finding that the most common treatment in the U.S. been cesarean-hysterectomy without placental removal since 1937. Though definitive studies have yet to be conducted, a growing body of evidence is suggesting that conservative management reduces maternal morbidity compared to cesarean-hysterectomy. International and national guidelines from several countries are examined. Comparisons between the U.S. and France that are addressed in the commentary include population and geography, structure of the health care system, physician training and acceptability, and patient acceptability. Considering the differences between countries, conservative management is feasible in the U.S. Different options for PAS management should be rigorously researched in multicenter international collaborations. Conservative management should be considered an option for women with PAS in the U.S., especially for those desiring fertility preservation.

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