Placenta Accreta Spectrum Disorders, a Formidable Challenge of Contemporary Obstetrics: A Case Series and Brief Review

Abstract

The prevalence of Placenta Accretea Spectrum disorders (PAS) is rising as a result of increasing caesarean section rates. PAS is considered high risk because of severe maternal morbidity and mortality associated with it. A peripartum hysterectomy is required leading to loss of future fertility. The knowledge and awareness of clinical risk factors, associated with possibility of PAS, is essential for antenatal diagnosis and optimum planning to reduce maternal morbidity. The purpose of present case series was to evaluate the risk factors, the circumstances and modality of diagnosis, clinical course, mode of management, and clinical outcome in six cases of PAS identified at a tertiary care centre, over a period of 18 months from February 2019 to August 2020. All the patients had histological confirmation of PAS. The most common risk factors observed were previous caesarean in 5 (83.33%) cases, concomitant placenta previa in 5 (83.33%), multiparity in 5 (83.33%), and increased maternal age in 4 (66.66%) cases. Ultrasound imaging was the imaging modality of choice, but missed diagnosis in two cases. Obstetric haemorrhage was the most common complication observed in 5 (83.33%) of cases. The primary mode of management was caesarean delivery followed by hysterectomy. The initiatives such as, Trial Of Labour After Caesarean (TOLAC) and External Cephalic Version (ECV) in primi breech can help reduce caesarean rates, and thus incidence of PAS. A knowledge of high risk factors and antenatal imaging expertise can help in timely diagnosis of PAS. A good outcome is dependent on early antenatal diagnosis, preparation for delivery and postpartum care. The management should involve a multidisciplinary team.

Keywords

• caesarean delivery
• caesarean hysterectomy
• postpartum haemorrhage