Placenta accreta spectrum: intraoperatory analysis for immediate tele-help

Abstract

Introduction

Placenta accreta spectrum (PAS) is a potentially fatal disease. A quarter of PAS cases are not detected during prenatal evaluations, so obstetricians without experience with this disease may encounter complex cases without having the necessary resources. We report a series of PAS intraoperative finding (IOF) cases and analyze useful strategies to improve patient outcomes.

Case Series

Four cases of PAS IOF are reported. These patients were women with previous pregnancies terminated by cesarean section, with placenta previa/anterior, and whose prenatal ultrasound did not detect PAS. Three patients were candidates for the postponement of cesarean section and/or hysterectomy. One case had active vaginal bleeding, so it was not feasible to delay surgery. Patients who benefited from delaying surgery or seeking additional help through telesupport had better clinical outcomes.

Conclusion

Decisions about which interventions to conduct and which to delay in cases of PAS intraoperative finding can determine the clinical outcome.

Keywords:

• Placenta accreta
• diagnostic techniques
• surgical
• telemedicine
• eHealth
• intersectoral collaboration

Acknowledgements

We would like to thank all those who contributed to the preparation of this document: Adriana Messa Bryon, Darío Santacruz, Antonio José Tascón, Lina Maria Vergara Galliadi, Stiven Ernesto Sinisterra Díaz, Alejandro Solo Nieto Calvache, María Andrea Zambrano, Juliana Maya, Juan Manuel Burgos Luna. There are no funding resources to declare in this submission.

Author contributions

Albaro José Nieto-Calvache: The author contributed to the design, planning and manuscript writing.

Paula Velásquez: The author contributed to the planning and final manuscript review.

Rudy Aguilera: The author contributed to the planning and manuscript writing.

Rozi Aditya Aryananda: The author contributed to the planning and manuscript writing.

Alejandra Hidalgo: The author contributed to the design and final manuscript review.

Disclosure statement

No potential conflict of interest was reported by the author(s).