Placenta accreta spectrum: 10 jaar ervaring in een tertiair perinataal centrum

Abstract

Placenta accreta spectrum disorders: a ten-year experience in a Belgian tertiary perinatal centre Introduction: Placenta accreta spectrum (PAS) disease carries significant morbidity. Due to its low prevalence, clinical evidence on diagnosis and management is scarce. The purpose of this study is to review the management of PAS cases in a single tertiary centre in Belgium in a 10-year period with a focus on ultrasound and magnetic resonance imaging (MRI). Methods: This single-centre retrospective observational study reviewed all medical records from January 2009 until December 2019 of patients with PAS that were treated at University Hospitals Leuven. Results: 32 patients were included in the analysis. Of the 61% (17/28) prenatally diagnosed cases, 47% (8/17) was diagnosed during routine trimestral screening. An MRI was performed in 46% (13/28). In total, 9 placenta accreta and 2 placenta increta were not diagnosed antenatally. There was an agreement between the MRI and pathological staging in 10/13 (77%). 43% (12/28) was delivered between 34-37 weeks. Median estimated blood loss was similar in FIGO stages 2, 3a and 3b. Total maternal morbidity rate was 14% (4/28) with only bladder or ureteral injuries occurring. There was no neonatal mortality in this reported cohort. Conclusion: Our data confirm reported pitfalls on diagnosis and management of PAS, with a high risk of complications and morbidities. Prenatal diagnosis is associated with better outcomes. Based on published international guidelines a multidisciplinary and specialised approach to diagnosis and treatment of PAS is proposed.