Placenta Accreta Spectrum: Surgical Management After Using Placental Magnetic Resonance Imaging (pMRI)

Abstract

Diagnosis accuracy is one of the most valuable support in the treatment of placenta accreta spectrum (PAS). Although ultrasound (US) is a highly reliable method for diagnosis, US has some limitations, and some useful information could be unavailable to plan the surgery. At this respect, invasion topography and placental extension to other organs are essential before making definitive decisions. While placental MRI (pMRI) started as diagnosis method, then, its utility changed by a topography study. At this regard, different placental invaded areas have a diverse risk according to the amount of blood supply, zone access, and dissection narrowness. Topographic information is helpful to plan the access of a precise vascular control and to avoid a possible organ damage. For all of these reasons, pMRI is a complementary study to surgical planning for PAS and not to perform a primary diagnosis. Therefore, it is not surprising that some specialists consider pMRI as an expensive and non-valuable method; and this is because they use the same technique and surgical alternatives in all patients. Nowadays, specialist understand the importance of getting more effective information that is mandatory to improve results; as a result of this, pMRI-PAS publications are growing. Acquisition of pMRI method is widely available, although continuous reading is necessary to improve the information. Hence, some units have faced this challenge and started a specific training, which includes a continuous feedback of informed images and a short debriefing with surgical team. We strongly believe that every effort to reduce maternal morbidity and mortality is worthwhile and should be attempted.