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Pineles BL, Sibai BM, Sentilhes L. Is conservative management of placenta accreta spectrum disorders practical in the United States? Am J Obstet Gynecol MFM 2023; 5:100749. [PMID: 36113717 DOI: 10.1016/j.ajogmf.2022.100749] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
This commentary discusses the issues related to conservative management (also called leaving the placenta in situ or intentional retention of the placenta) of placenta accreta spectrum disorders. Considerations related to placenta accreta spectrum disorder management in the United States are compared with France, where conservative management is a well-accepted management option. The history of placenta accreta spectrum disorder treatment is reviewed, finding that since 1937, the most common treatment in the United States been cesarean-hysterectomy without placental removal. Although definitive studies have yet to be conducted, a growing body of evidence suggests that conservative management is able to reduce maternal morbidity, compared with cesarean-hysterectomy. International and national guidelines from several countries are examined. Comparisons between the United States and France that are addressed in the commentary include population and geography, structure of the healthcare system, physician training and acceptability, and patient acceptability. Considering the differences between the countries, conservative management is feasible in the United States. Different options for placenta accreta spectrum disorder management should be rigorously researched in multicenter international collaborations. Conservative management should be considered as an option for women with placenta accreta spectrum disorders in the United States, especially for those desiring fertility preservation.
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Affiliation(s)
- Beth L Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Sibai).
| | - Baha M Sibai
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Sibai)
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France (Dr Sentilhes)
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Sentilhes L, Seco A, Kayem G, Deneux-Tharaux C. Postdischarge outcomes of readmitted women included in the PACCRETA study. Am J Obstet Gynecol 2022; 227:795-798. [PMID: 35772474 DOI: 10.1016/j.ajog.2022.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Loic Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - Aurélien Seco
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Institut National de la Sante et de la Recherche Medicale, National Institute For Agricultural Research, University Hospital Department-Risks in Pregnancy, Université de Paris, Paris, France; Unité de Recherche Clinique Centre d'Investigation Clinique Paris Descartes Necker-Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Kayem
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Institut National de la Sante et de la Recherche Medicale, National Institute For Agricultural Research, University Hospital Department-Risks in Pregnancy, Université de Paris, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Institut National de la Sante et de la Recherche Medicale, National Institute For Agricultural Research, University Hospital Department-Risks in Pregnancy, Université de Paris, Paris, France
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Sentilhes L, Deneux-Tharaux C, Kayem G. Conservative management or cesarean hysterectomy for placenta accreta spectrum? Local resources and organization of care matter. Am J Obstet Gynecol 2022; 226:872. [PMID: 35065018 DOI: 10.1016/j.ajog.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/01/2022]
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Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders. Medicina (B Aires) 2022; 58:medicina58050678. [PMID: 35630092 PMCID: PMC9144771 DOI: 10.3390/medicina58050678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Management strategies for pregnancies with abnormal adherence/invasion of the placenta (placenta accreta spectrum, PAS) vary between centers. Expectant management (EM), defined as leaving the placenta in situ after the delivery of the baby, until its complete decomposition and elimination, has become a potential option for PAS disorders in selected cases, in which the risk of Caesarean hysterectomy is very high. However, expectant management has its own risks and complications. The aim of this study was to describe the rates of subsequent hysterectomy (HT) in patients that underwent EM for the treatment of PAS disorders. We reviewed the literature on the subject and found 12 studies reporting cases of HT after initial intended EM. The studies included 1918 pregnant women diagnosed with PAS, of whom 518 (27.1%) underwent EM. Out of these, 121 (33.2%) required subsequent HT in the 12 months following delivery. The rates of HT after initial EM were very different between the studies, ranging from 0 to 85.7%, reflecting the different characteristics of the patients and different institutional management protocols. Prospective multicenter studies, in which the inclusion criteria and management strategies would be uniform, are needed to better understand the role EM might play in the treatment of PAS disorders.
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Sentilhes L, Deneux-Tharaux C, Kayem G. Assessing conservative management vs cesarean hysterectomy for placenta accreta spectrum: the importance of comparing data collected at the same study period. Am J Obstet Gynecol 2022; 227:365-366. [PMID: 35288088 DOI: 10.1016/j.ajog.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
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Sentilhes L, Kayem G, Deneux-Tharaux C. Conservative management or cesarean hysterectomy for placenta percreta? A subgroup analysis of the PACCRETA study is needed. Am J Obstet Gynecol 2022; 227:117-118. [PMID: 35101409 DOI: 10.1016/j.ajog.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Loic Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - Gilles Kayem
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale, Institut Nationale de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale, Institut Nationale de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France
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Trends, characteristics, and outcomes of conservative management for placenta percreta. Arch Gynecol Obstet 2022; 306:913-920. [DOI: 10.1007/s00404-021-06384-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/27/2021] [Indexed: 11/02/2022]
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van Beekhuizen HJ, Stefanovic V, Schwickert A, Henrich W, Fox KA, MHallem Gziri M, Sentilhes L, Gronbeck L, Chantraine F, Morel O, Bertholdt C, Braun T, Rijken MJ, Duvekot JJ. A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:12-20. [PMID: 33483943 PMCID: PMC8048500 DOI: 10.1111/aogs.14096] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/21/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
Introduction Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort. Material and methods Data from women in 15 referral centers of the International Society of PAS (IS‐PAS) were analyzed and correlated with the clinical classification of the IS‐PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10. Results In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150‐20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P < .001). The mode of delivery in the majority of women (n = 252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (P < .002) in 2018‐2019 compared with 2009‐2017, suggesting a positive learning curve. Conclusions In referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred.
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Affiliation(s)
- Heleen J van Beekhuizen
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Alexander Schwickert
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Mina MHallem Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Lene Gronbeck
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederic Chantraine
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Liège, Site CHR Citadelle, Liège, Belgium
| | - Oliver Morel
- Nancy Regional and University Hospital Center (CHRU, Women's Division, Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI) Unit, Inserm, Université de Lorraine, Nancy, France
| | - Charline Bertholdt
- Nancy Regional and University Hospital Center (CHRU, Women's Division, Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI) Unit, Inserm, Université de Lorraine, Nancy, France
| | - Thorsten Braun
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Julius Global Health, The Julius center for Health Sciences and Primary Care, University Medical center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical center Rotterdam, Rotterdam, the Netherlands
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Kayem G, Seco A, Beucher G, Dupont C, Branger B, Crenn Hebert C, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Dreyfus M, Vendittelli F, Patrier S, Deneux-Tharaux C, Sentilhes L. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021; 128:1646-1655. [PMID: 33393174 DOI: 10.1111/1471-0528.16647] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. DESIGN Prospective population-based study. SETTING All 176 maternity hospitals of eight French regions. POPULATION Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. METHODS Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. MAIN OUTCOME MEASURES Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. RESULTS The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. CONCLUSION More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. TWEETABLE ABSTRACT Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
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Affiliation(s)
- G Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.,CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - A Seco
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - G Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - C Dupont
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.,Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - B Branger
- Réseau « Sécurité Naissance - Naître ensemble » des Pays-de-la-Loire, France
| | - C Crenn Hebert
- Louis Mourier University Hospital, APHP, Colombes, France.,Réseau Périnatal des Hauts de Seine, PERINAT92, Issy-les-Moulineaux, France
| | - C Huissoud
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - J Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,CHRU Nancy, Réseau Périnatal Lorrain, France
| | - N Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - B Langer
- CHU de Strasbourg, Strasbourg, France
| | | | - O Morel
- CHRU de Nancy, Nancy, France
| | - M P Bonnet
- Anaesthesia and Critical Care department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - E Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - L Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, France
| | - C Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - P Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - R C Rudigoz
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - M Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - F Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, CHU de Clermont-Ferrand, France.,CNRS, SIGMA Clermont, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - C Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
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