Conservative management for placenta accreta spectrum disorders: experience of a regional hospital from 2013 to 2021

Yiu Fai Wong; Tsz Kin Lo; Viola Ying Tze Chan; Vivian Kwun Sin Ng; Wai Kuen Yung; Hin Hung Tsang; Chi Hung Koo; Danny Hing Yan Cho; Wai Lam Lau; Wing Cheong Leung

doi:10.12809/hkjgom.23.2.342

Authors

Yiu Fai Wong
Tsz Kin Lo
Viola Ying Tze Chan
Vivian Kwun Sin Ng
Wai Kuen Yung
Hin Hung Tsang
Chi Hung Koo
Danny Hing Yan Cho
Wai Lam Lau
Wing Cheong Leung

DOI:

https://doi.org/10.12809/hkjgom.23.2.342

Keywords:

Conservative treatment, Hysterectomy, Placenta, Placenta accreta, Postpartum haemorrhage

Abstract

Introduction: Conservative management by leaving the placenta in situ for placenta accreta spectrum (PAS) disorders can preserve the uterus with reduced surgical complications. This study aims to review the outcomes of planned conservative management for PAS disorders between January 2013 and December 2021.
Methods: The medical records of patients with clinically and/or histopathologically confirmed PAS disorders who underwent conservative management by leaving the placenta in situ between 1 January 2013 and 31 December 2021 at Kwong Wah Hospital, Hong Kong, were retrospectively reviewed. Uterine artery embolisation and various haemostatic methods were used to control bleeding.
Results: A total of 17 patients with PAS disorders were conservatively treated by leaving the placenta in situ. Of these, 15 patients had major placenta praevia; 16 patients had a history of Caesarean delivery; and 10 patients presented with sonographic features of PAS disorders. Intraoperatively, eight patients had partial placenta left in situ, whereas five patients had the entire placenta left in situ. All patients had good maternal outcomes and recovery, except for four patients who had major complications during the immediate postpartum period. Two patients eventually required a hysterectomy.
Conclusion: Planned conservative management for PAS disorders can achieve good clinical outcomes in a regional hospital with a multidisciplinary team.

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