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Conservative vs. Radical Management of Placenta Accreta Spectrum (PAS)

  • Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux)
  • Published:
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Abstract

Purpose of Review

We review the advantages, disadvantages, and possible risks of current therapeutic alternatives for placenta accreta spectrum (PAS). Details and proper indications may change from one case to another, especially depending on the available resources, practitioner skill, and patient preference. Many treatments are routinely performed without appropriate analysis, which could result in a high rate morbidity. In contrast, undesirable outcomes are typically not reported in the literature, which may lead obstetricians to follow dangerous procedures without accurate information on possible consequences.

Recent Findings

The proper use of the topography of invasion, and the knowledge of which pedicles are involved and why, is necessary to determine the best method for vascular control. In other words, prenatal evaluation is not entirely accurate, so the use of suitable intra-surgical staging could contribute to the correct diagnosis in the non-invaded uterus.

Summary

Appropriate knowledge of the involved pedicles and their correct access after opening of the pelvic fascia will help in tailoring methods to stop the bleeding and do not depend of high-cost equipment. Complications associated with the use of handmade hemostasis have not been published, in contrast to serious complications caused by unwanted arterial embolization. As happens with other complicated surgeries, the proper management of pedicles and access results in better results. Acquiring new skills is necessary and possible; meanwhile, the use of low-risk techniques is advisable.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. CEMIC University Hospital, Obstetrics and Gynecology Department and School of Medicine, University of Buenos Aires, Galván 4102, C1431, Buenos Aires, Argentina

    Jose M. Palacios-Jaraquemada

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Palacios-Jaraquemada, J.M. Conservative vs. Radical Management of Placenta Accreta Spectrum (PAS). Curr Obstet Gynecol Rep 9, 36–43 (2020). https://doi.org/10.1007/s13669-019-00274-9

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