Expectant management of placenta accreta spectrum disorders in a designated center

Abstract

Introduction: expectant management without removal of the placenta is becoming more frequent in pregnant women with placenta accreta spectrum disorders (PASD), it avoids the morbidity associated with hysterectomy, preserves fertility, and improves uterine vascular conditions, to reduce bleeding complications. Objective: to describe the results of the management of PASD in pregnant women in which the placenta was left in situ. Material and method: prospective, descriptive, longitudinal, study, from November 2018 to December 2021, at "Enrique Cabrera" general teaching hospital, including five patients with diagnosis of PASD, percreta variety, in which expectant management was decided, according to the care protocol of the centre for these disorders. Demographic, obstetric variables and those related to the imposed management were analysed and processed using descriptive statistical techniques (frequencies and percentages). Results: the mean age of patients was 32.4 years, all had previous caesarean section and association with placenta previa. Mean gestational age at diagnosis was 32.9 and in caesarean section 36.4. Diagnostic cytoscopy was performed in all of them, as well as preoperative tranexamic acid was indicated, hypogastric artery ligation was performed, and postpartum methotrexate was administered.Cesarean section was planned in four patients and was urgent, due to bleeding, in another. Conclusions: Leaving the placenta in situ is a valid alternative for managing the PASD, but it requires planned and multidisciplinary management.