Placenta Accreta Spectrum: Basic Science, Diagnosis, Classification and Management

Contents
Contributors
Chapter 1: History of Placenta Accreta Spectrum
	References
Chapter 2: Epidemiology of Placenta Accreta Spectrum: A Comprehensive Review of Current Evidence
	Introduction
	Definition and Terminology
	Incidence and Increasing Trend Globally
	Morbidity and Mortality
	Risk Factors
	Caesarean Section
	Placenta Praevia
	Advanced Maternal Age
	Assisted Reproductive Technologies
	Previous Gynaecological History
	Previous Obstetric History
	Management
	Conclusion
	References
Chapter 3: Pathogenesis of Placenta Accreta Spectrum
	References
Chapter 4: Anatomy of Placenta Accreta Spectrum
	General Overview
	Pelvic Spaces or Areas
		Vesicouterine Space (VUS)
		Paracervical Space
		Prevesical Space
		Paravesical Space
		Pararectal Space
		Parametrial Space
	Vascular Anatomy
		Proximal Vascular Control
		Uterine Vascular Areas
	Anterior Placenta Invasion
		Posterior Upper Bladder
		Posterior Lower Bladder
	Lateral Invasion: The Parametrium
	Posterior Invasion
	Uterine Blood Supply
	Anatomy Learning for Surgeons
	Summary
	References
Chapter 5: Classification of Placenta Accreta Spectrum
	Introduction
	Clinicopathology Classification
	Vascular Classification
	Placental-Type Invasion
		Type 1
		Type 2
		Type 3
		Type 4
		Type 5
	Placental Mapping for Prenatal Diagnosis of Placenta Accreta Spectrum Grading
	Conclusion
	References
Chapter 6: Diagnosis of Placenta Accreta Spectrum: Clinical and Radiological Diagnosis of Placenta Accreta Spectrum and the Ability of Sonographic and MRI Findings to Predict Definitive Diagnosis
	The Importance of Antenatal Diagnosis of Placenta Accreta Spectrum
	Antenatal Diagnosis: Role of Different Imaging Modalities
	First Trimester Imaging
	Second or Third Trimester Ultrasound Evaluation
	MRI Evaluation
	Special Considerations
	References
Chapter 7: Definitive Management of Placenta Accreta Spectrum
	Introduction
	Preoperative Preparation
	Anaesthesia
	Surgical Management of an Antenatally Suspected Case
	Surgical Management of an Unexpected Case
	Postoperative Considerations
	Surgical Morbidity
	Psychological Impact
	Conclusion
	References
Chapter 8: Conservative Management of Placenta Accreta Spectrum
	Definition
	Risk Factors
	Clinical Presentation and Diagnosis
	Management
	Timing of Delivery
	Cesarean Delivery and Hysterectomy
	Conservative Management
	Follow-Up After Conservative Management
	Long-Term Considerations
	References
Chapter 9: Adjunctive Treatment of Placenta Accreta Spectrum
	Introduction
	Surgical Control of Bleeding
		Uterine Artery Embolization
		Internal Iliac Artery Ligation
		Endovascular Balloon Occlusion of the Pelvic Circulation
		Uterine Compression Sutures
	Use of Tranexamic Acid
	Investigational Therapies
		High-Intensity Focused Ultrasound
		Methotrexate
	Conclusions
	References
Chapter 10: Prediction and Risk Reduction of Clinical Outcomes of Placenta Accreta Spectrum
	Introduction
	PAR-A (Placenta Accreta Risk–Antepartum) and PAR-P (Placenta Accreta Risk–Peripartum) Scores
		Score Development
		Score Components
		Score Performance
		Score Applicability
		Disadvantages and Limitations
	Conservative Management of PAS (CON-PAS) Score
		Score Development
		Score Components
		Score Performance
		Score Applicability
		Disadvantages and Limitations
	Conclusion
	References
Chapter 11: Evidence-Based Management of Placenta Accreta Spectrum
	Introduction
	Evidence-Based Recommendations on Management of PAS
		Antenatal Screening
		Transfer of Care
		Delivery Planning
		Preoperative Preparation
		Intraoperative Management
		Postoperative Care
	Barriers to Evidence-Based Practice: Why Does Global Practice Not Strictly Follow Guidelines?
	Validity of Established Practice: Why Does Established Practice Not Steer Guidelines?
	Conclusion
	References
Chapter 12: Prevention of Placenta Accreta Spectrum Disorders
	Primary Prevention of PAS
		Restraining the Increase in the Number of CS, Especially in Primiparous
	Orientation of Pregnant Women with a Scar on the Uterus After CS to Attempt Vaginal Delivery in the Absence of Other Indications for CS
	Modifying Other PAS-Related Risk Factors
		Placenta Previa (РР)
		Previous Uterine Surgery
		Advanced Maternal Age
		Interpregnancy Interval
		Smoking
		CS Technique
		Assisted Reproductive Technologies
	Secondary Prevention of PAS
	References
Chapter 13: Setting Up a Referral Center for Placenta Accreta Spectrum
	Introduction
	What Constitutes a PAS Center of Excellence?
	A Quick Overview
	Research
	Conclusion
	References
Chapter 14: Management of PAS in Low-Resource Settings
	Introduction
	Prenatal Diagnosis
		Ultrasound Approach and Placenta Accreta Spectrum Markers
			First-Trimester Evaluation
			Second- and Third-Trimester Evaluation
	Planning for Delivery
		Where to Deliver?
		When to Deliver?
		Who Should Deliver?
	MDT and Hospitalization
	Surgical Management
		Urologic Injury
		Type of Incisions for Access
		Blood Conservation Techniques
		Surgical Methods
		Conservative Techniques
		Radical Management
			Steps of Classical Hysterectomy
			Intraoperative Considerations According to Recent Guidelines [1]
			Planned Hysterectomy
	Unexpected Placenta Accreta or Intraoperative Diagnosis
	Postoperative Care
	Anesthetic Management
	Conservative Management
	References
Chapter 15: Management of Placenta Accreta Spectrum in the Second Trimester
	Introduction
	Pathophysiology
	Diagnosis
	Management
		Second-Trimester Termination
		Scheduled Hysterotomy
		Peripartum Hysterectomy
		Leaving Placenta In Situ
	Conclusion
	References
Chapter 16: Long-Term Outcomes of Conservative Management of PAS: Long-Term Sequences and Impact on Future Pregnancies
	Introduction
	An Old, Long, but Meaningful Story
	Definitions and Problems
	Lines of Conservative Management [5]
	Long-Term Complications
		Intrauterine Synechiae
		Impaired Fertility
		Negative Impact on Subsequent Pregnancies (Fig. 16.1)
		Possible Effect of Arterial Embolization {Sentilhes, 2010 #507}
		Recurrence
	Summary
	References