Piñas Carrillo, A; Chandraharan, E
(2019)
Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure.
Womens Health (Lond), 15.
p. 1745506519878081.
ISSN 1745-5065
https://doi.org/10.1177/1745506519878081
SGUL Authors: Chandraharan, Edwin
Abstract
Abnormal invasion of placenta or placenta accreta spectrum disorders refer to the penetration of the trophoblastic tissue through the decidua basalis into the underlying uterine myometrium, the uterine serosa or even beyond, extending to pelvic organs. It is classified depending on the degree of invasion into placenta accreta (invasion <50% of the myometrium), increta (invasion >50% of the myometrium) and percreta (invading the serosa and adjacent pelvic organs). Clinical diagnosis is made intra-operatively; however, the confirmative diagnosis can only be made after a histopathological examination. The incidence of abnormal invasion of placenta has increased worldwide, mostly as a consequence of the rise in caesarean section rates, from 1 in 2500 pregnancies to 1 in 500 pregnancies. The importance of the disease is due to the increased maternal and foetal morbidity and mortality. Foetal implications are mainly due to iatrogenic prematurity, while maternal implications are mostly the increased risk of obstetric haemorrhage and surgical complications. The average blood loss is 3000-5000 mL, and up to 90% of the patients require a blood transfusion. An accurate and timely antenatal diagnosis is essential to improve outcomes. The traditional management of abnormal invasion of placenta has been a peripartum hysterectomy; however, the increased incidence and the short- and long-term consequences of a radical approach have led to the development of more conservative techniques, such as the intentional retention of the placenta, partial myometrial excision and the 'Triple P procedure'. Irrespective of the surgical technique of choice, women with a high suspicion or confirmed abnormally invasive placenta should be managed in a specialist centre with surgical expertise with a multi-disciplinary team who is experienced in managing these complex cases with an immediate availability of blood products, interventional radiology service, an intensive care unit and a neonatal intensive care unit to optimize the outcomes.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2019
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
Keywords: |
Triple P procedure, intentional retention of placenta, peripartum hysterectomy, placenta accreta spectrum disorders, placenta percreta, prophylactive endovascular occlusive balloons, the ‘smudged egg’ sign, intentional retention of placenta, peripartum hysterectomy, placenta accreta spectrum disorders, placenta percreta, prophylactive endovascular occlusive balloons, the 'smudged egg' sign, Triple P procedure, 1114 Paediatrics And Reproductive Medicine, 1117 Public Health And Health Services, Obstetrics & Reproductive Medicine |
SGUL Research Institute / Research Centre: |
Academic Structure > Institute of Medical & Biomedical Education (IMBE) |
Journal or Publication Title: |
Womens Health (Lond) |
ISSN: |
1745-5065 |
Language: |
eng |
Dates: |
Date | Event |
---|
3 October 2019 | Published | 2 September 2019 | Accepted |
|
Publisher License: |
Creative Commons: Attribution-Noncommercial 4.0 |
PubMed ID: |
31578123 |
Web of Science ID: |
WOS:000488970500001 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/111443 |
Publisher's version: |
https://doi.org/10.1177/1745506519878081 |
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