Immediate hysterectomy following delivery, the current standard surgical treatment
for placenta accreta spectrum (PAS) in the United States, frequently leads to major
morbidity. Every case, regardless of predelivery diagnosis or surgical expertise,
holds the potential for life-threatening hemorrhage. The risk of death for the most
severe forms of PAS is reported to be as high as 1% to 7%.
1
,2
Severe morbidity (not including hysterectomy or single-unit transfusions) occurs
in one-quarter to one-half of cases. Intensive care unit admission is common or, in
many hospitals, routine. Furthermore, published data probably underestimate the true
societal burden of PAS, because lower-volume centers and those with the least favorable
outcomes may be less likely to publish their data. Even in busy specialty centers
with extensive PAS expertise and every available resource, planned cases of PAS hysterectomy
commonly leads to massive blood loss and a need for life-saving transfusion and intensive
cardiorespiratory support. In short, PAS is a morbid disease, and the standard treatment
in the United States and much of the world is, soberingly, hazardous.To read this article in full you will need to make a payment
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References
- Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta.Am J Obstet Gynecol. 2018; 219 (193.e1–9)
- The management of placenta percreta: conservative and operative strategies.Am J Obstet Gynecol. 1996; 175: 1632-1638
- Fertility and pregnancy outcomes following conservative treatment for placenta accreta.Hum Reprod. 2010; 25: 2803-2810
- Lived experiences of patients with placenta accreta spectrum in Utah: a qualitative study of semi-structured interviews.BMJ Open. 2021; 11e052766
- Living beyond placenta accreta spectrum: parent's experience of the postnatal journey and recommendations for an integrated care pathway.BMC Pregnancy Childbirth. 2022; 22: 397
Article info
Publication history
Accepted:
December 31,
2022
Received in revised form:
December 27,
2022
Received:
October 18,
2022
Footnotes
The author reports no conflict of interest.
B.D.E. reports receiving funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under grant number K23HD106009 to study conservative management as an alternative to immediate hysterectomy for placenta accreta spectrum.
Identification
Copyright
© 2023 Published by Elsevier Inc.
