Placenta Accreta Spectrum Disorder

Question 1

What is placenta accrete spectrum disorder?

Answer 1

morbidly adherent placenta to the submucosa of the uterus

Question 2

What are ultrasound findings suggestive of placenta accrete spectrum?

Answer 2

• bulging of placental myometrial tissue into bladder
• retroplacetal myometrial thickness less than 1mm
• loss of hypoechoic retroplacental space
• hypervascularity
• increase lacunae presence (Swiss cheese)

Question 3

What is the role of MRI in the diagnosis of placenta accrete spectrum?

Answer 3

For confirmatory purposes and can provide visualization of lateral and posterior tissue.

Sensitivity is 80-85%

Question 4

Is MRI superior to ultrasound for the diagnosis of placenta accrete spectrum?

Answer 4

No.

Sonogram sensitivity is 77-97%

Question 5

What are risk factors for placenta accrete spectrum?

Answer 5

Prior uterine curettage or fundal surgery 
Prior cesarean section 
Placental previa
Prior pelvic infection 
AMA
Grand multiparty 
Submucosal fibroid

Question 6

If placenta accrete spectrum is suspected, how do you counsel the patient?

Answer 6

Complications around delivery include maternal death, shock, injuries to urinary tract, GI, recurrent laparotomy, need for blood transfusion, ICU admission. Multidisciplinary approach.

Question 7

How will you manage the pregnancy if placenta accrete spectrum is diagnosed on US?

Answer 7

• Detailed anatomy
• Growth every 4 weeks
• Antenatal testing at 32 weeks
• +/- MRI
• Delivery at facility able to rapidly transfuse, ICU, NICU, around the clock anesthesia
• Multidiscplinary consult with anesthesia and general surgery or Gyn Onc.

Question 8

When do you plan delivery of a patient with placenta accrete spectrum?

Answer 8

C-hyst at 34 weeks

Question 9

Describe your delivery plan for a patient with placenta accrete spectrum?

Answer 9

• Steroids at 33 weeks 5 days and 33 weeks and 6 days
• Placement of intraarterial balloon catheter
• Blood bank consultation
• C-section, Clamp incision site, proceed with hysterectomy without delivery of placenta

Question 10

What are the risks of cesarean hysterectomy?

Answer 10

• Hemorrhage
• Risk of ICU admission due to hemorrhage
• Damage to GI/GU systems/Ovaries

Question 11

Describe your surgical approach to a cesarean hysterectomy for placenta accrete spectrum.

Answer 11

clamp uterine incision and perform hysterectomy with placenta in place