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Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists
  1. Omar Touhami1,
  2. Lisa Allen2,
  3. Homero Flores Mendoza2,
  4. M Alix Murphy2 and
  5. Sebastian Rupert Hobson2
  1. 1Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Centre Intégré Universitaire de Santé et Services Sociaux CIUSSS du Saguenay-Lac-Saint-Jean, Sherbrooke University, Sherbrooke, Quebec, Canada
  2. 2Department of Obstetrics and Gynecology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Dr Omar Touhami, Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Centre Intégré Universitaire de Santé et Services Sociaux, CIUSSS du Saguenay—Lac-Saint-Jean, Sherbrooke University, Sherbrooke, Quebec, Canada; touhamiomar{at}yahoo.fr

Abstract

Placenta accreta spectrum disorders are a major risk factor for severe postpartum hemorrhage and maternal death worldwide, with a rapidly growing incidence in recent decades due to increasing rates of cesarean section. Placenta accreta spectrum disorders represent a complex surgical challenge, with the primary concern of massive obstetrical hemorrhagic sequelae and organ damage, occurring in the context of potentially significant anatomical and physiological changes of pregnancy.

Most international obstetrical organizations have published guidelines on placenta accreta spectrum, embracing the creation of regionalized ‘Centers of Excellence’ in the diagnosis and management of placenta accreta spectrum, which includes a dedicated multidisciplinary surgical team. One mandatory criterion for these Centers of Excellence is the presence of a surgeon experienced in complex pelvic surgeries. Indeed, many institutions in the United States and worldwide rely on gynecologic oncologists in the surgical management of placenta accreta spectrum due to their experience and skills in complex pelvic surgery.

Surgical management of placenta accreta spectrum frequently includes challenging pelvic dissection in regions with distortion of anatomy alongside large aberrant neovascularization. With a goal of definitive management through cesarean hysterectomy, surgeons require a systematic and thoughtful approach to promote prevention of urologic injuries, embrace measures to secure challenging hemostasis and, in selected cases, employ conservative management where indicated or desired.

In this review recommendations are made for gynecologic oncologists regarding the management and important considerations in the successful care of placenta accreta spectrum disorders. Where required, gynecologic oncologists are encouraged to be proactively involved in the management of placenta accreta spectrum, not only intra-operatively, but also in the development of clinical protocols, guidelines, and pre-operative counseling of patients, as a ‘call if needed’ approach is suboptimal for this potentially major and life-threatening condition.

  • Gynecologic Surgical Procedures
  • Surgical Procedures, Operative

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Footnotes

  • Contributors OT: review concept, writing the urologic considerations section. LA: revising the article. HFM: writing the 'Non-Conservative Surgical Management (Caesarean-Hysterectomy)' section. MAM: writing the 'Measures to Minimize Surgical Blood Loss' section. SRH: writing the 'Conservative Management' section.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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