Observational studyActa obstetricia et gynecologica Scandinavica2021
A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum.
Observational study in Acta obstetricia et gynecologica Scandinavica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 42 citations in OpenAlex.
- Uterus-preserving surgery for placenta accreta spectrum: An expert, illustrated review of techniques and its outcomes.Acta obstetricia et gynecologica Scandinavica · 2026Review
- Uterus-Preserving Surgery for Placenta Previa and Placenta Accreta Spectrum: Retrospective Analysis of the Evolution of a Standardized Step-Up Approach in a 13-Year Single-Surgeon Cohort of 324 Cases.Medicina (Kaunas, Lithuania) · 2026Article
- Undiagnosed placenta accreta spectrum complicated by massive haemorrhage during mid-trimester medical termination of pregnancy: a case report.Case reports in women's health · 2026Article
- Management and outcomes of 308 placenta accreta spectrum cases at a multidisciplinary tertiary center in Turkey: a 16-year experience.BMC pregnancy and childbirth · 2026Observational
- A Novel Uterus-Sparing Technique for Placenta Accreta Spectrum (PAS), at a Tertiary Center.Obstetrics and gynecology international · 2026Article
- Hemostatic compression treatment of central placenta previa with modified Cho suture.Journal of surgical case reports · 2025Article
- Induced Abortion After Previous Caesarean Section: A Scoping Review.The Australian & New Zealand journal of obstetrics & gynaecology · 2025Article
- Intended Conservative Management Versus Caesarean Hysterectomy for Known or Suspected Placenta Accreta Spectrum: A Cost-Effectiveness Analysis.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Opportunities for, and barriers to, uterus-preserving surgical techniques for placenta accreta spectrum.Acta obstetricia et gynecologica Scandinavica · 2025Article
- International multicenter prospective evaluation of PAS management in 23 IS-PAS member centers.Acta obstetricia et gynecologica Scandinavica · 2025Article
- The Underlying Molecular Mechanisms of the Placenta Accreta Spectrum: A Narrative Review.International journal of molecular sciences · 2024Review
- Placenta Accreta Spectrum (PAS): Diagnosis, Clinical Presentation, Therapeutic Approaches, and Clinical Outcomes.Medicina (Kaunas, Lithuania) · 2024Review
- Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid.Journal of clinical medicine · 2023Article
- Psychological burden of women with placenta accreta spectrum: some specific features.Acta obstetricia et gynecologica Scandinavica · 2023Article
- V-shaped uterine suture (VUS): A new non-compression penetrating suture technique to control lower uterine bleeding during cesarean section for placenta previa.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders.Medicina (Kaunas, Lithuania) · 2022Review
- Emergent versus planned delivery in patients with placenta accreta spectrum disorders: A retrospective study.Medicine · 2021Article
- Effects of Placenta Location in Pregnancy Outcomes of Placenta Accreta Spectrum (PAS): A Retrospective Cohort Study.Journal of family & reproductive health · 2021Article
Corrections and comments
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Authors and funding
15 authors at 11 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionManagement 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
methodsData 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.
resultsIn 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.
conclusionsIn 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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