The Need for Presurgical Evaluation for Placenta Accreta Spectrum

Author:

Einerson Brett D.1,Shamshirsaz Alireza A.23,Stephenson Megan L.4,Khandelwal Meena5,Holt Roxane6,Duzyj Christina M.78,Shrivastava Vineet K.9

Affiliation:

1. University of Utah Health, Salt Lake City, Utah

2. Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts

3. Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts

4. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Kaiser Permanente, Santa Clara, California

5. Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey

6. Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois

7. Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts

8. Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, Massachusetts

9. MemorialCare Miller Children's & Women's Hospital, Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Long Beach, California

Abstract

Staging or grading of placenta accreta spectrum has historically relied on histopathologic evaluation of placental and uterine specimens. This approach has limited utility, since it is retrospective in nature and does not allow for presurgical planning. Here, we argue for a paradigm shift to use of clinical and imaging characteristics to define the presurgical stage. We summarize past attempts at staging, and define a new data-driven approach to determining the stage prior to delivery. Use of this model may help hospitals direct patients to the most appropriate level of care for workup and management of placenta accreta spectrum. Key Points

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

Reference43 articles.

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