VP44.19: Placenta accreta spectrum intraoperative finding: always evaluate if possible – to defer surgery and if “tele‐help” is available

Abstract

Placenta accreta spectrum (PAS) is a potentially fatal disease. A quarter of PAS cases are not detected in prenatal evaluations, so obstetricians without experience in this disease may be faced with complex cases without having the necessary resources. We report a series of PAS intraoperative finding (IOF) cases and analyse useful strategies to improve outcomes. Four cases of PAS IOF are reported. These were women with previous pregnancies terminated by Caesarean section, with placenta previa or anterior, whose prenatal ultrasound did not detect PAS. Three patients were candidates for postponement of Caesarean section and / or hysterectomy. One case had active vaginal bleeding, so it was not feasible to defer surgery. Patients who benefited from delaying surgery or seeking additional help through tele-support had better clinical outcomes. In conclusion, deciding which interventions to carry out and which to defer, during a PAS intraoperative finding, is decisive for the clinical outcome.