Placenta Accreta Spectrum Disorders: A Canadian Tertiary Care Centre’s Experience Over 10 years

IF 2 Q2 OBSTETRICS & GYNECOLOGY Journal of obstetrics and gynaecology Canada Pub Date : 2024-12-31 DOI:10.1016/j.jogc.2024.102757
Catherine Lu MD , Carol Schneider MD , Caroline Corbett MD , Anet Maksymowicz MD , Devon Evans MD
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Abstract

Objectives

The placenta accreta spectrum disorders (PASD) are associated with significant maternal and neonatal morbidity and mortality worldwide. As cesarean delivery rates increase, so does the rate of PASD. PASD antepartum diagnosis and perioperative management are evolving, and we primarily aimed to share our tertiary care centre’s institutional approach and outcomes over a decade.

Methods

A retrospective medical record review of cesarean hysterectomy for suspected or confirmed PASD was conducted at a single tertiary centre in Canada from 2010 to 2021.

Results

A total of 46 records remained after applying the exclusion criteria, with a diagnosis of PASD in 94% of cases, and 20% consistent with accreta, 48% with increta, and 26% with percreta. Cesarean hysterectomies were conducted on an unscheduled emergency basis in 41% of cases. All cases had antenatal ultrasound imaging, and 57% received an antenatal MRI. Prophylactic ureteric stenting occurred in 37% of cases. Mean total operative time was 97 minutes, and 50% of cases received an intraoperative blood transfusion. Ureteric injury occurred in 2% of cases, and admission to the intensive care unit in 13% of cases.

Conclusions

PASD is a complex and highly morbid condition. We have shared our institutional experience and explored some variations in practice, including the use of prophylactic ureteric stenting. Additional research is needed to further explore the optimal methods to diagnose and manage this complex disorder.
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胎盘增生谱系障碍:加拿大三级保健中心的经验超过10年。
目的:胎盘增生谱系障碍(PASD)与全球孕产妇和新生儿的发病率和死亡率相关。随着剖宫产率的增加,PASD的发生率也在增加。产前诊断和围手术期管理正在不断发展,我们的主要目标是分享我们三级护理中心十年来的机构方法和成果。方法:回顾性分析2010年至2021年XXX某三级中心剖宫产子宫切除术疑似或确诊PASD的病例。结果:在排除标准后,总共保留了46例记录,其中94%的病例诊断为PASD, 20%符合accreta, 48%符合increta, 26%符合percreta。41%的剖宫产子宫切除术是在计划外的紧急情况下进行的。所有病例进行了产前超声成像,57%的患者接受了产前MRI检查。预防性输尿管支架置入术发生率为37%。平均总手术时间为97分钟,50%的病例接受术中输血。输尿管损伤发生率为2%,住院率为13%。结论:PASD是一种复杂的、高度病态的疾病。我们分享了我们的机构经验,并探讨了实践中的一些变化,包括使用预防性输尿管支架置入。需要进一步的研究来进一步探索诊断和管理这种复杂疾病的最佳方法。
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来源期刊
CiteScore
3.30
自引率
5.60%
发文量
302
审稿时长
32 days
期刊介绍: Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.
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