Abstract：
UNASSIGNED: Placenta accreta spectrum (PAS) represents a range of disorders characterized by abnormal placental invasion and is associated with severe maternal morbidity and mortality.
UNASSIGNED: The aim of this study was to review and compare the most recently published major guidelines on the diagnosis and management of this potentially life-threatening obstetric complication.
UNASSIGNED: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the International Society for Abnormally Invasive Placenta, the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada on PAS disorders was carried out.
UNASSIGNED: There is a consensus among the reviewed guidelines regarding the definition and the diagnosis of PAS using specific sonographic signs. In addition, they all agree that the use of magnetic resonance imaging should be limited to the evaluation of the extension to pelvic organs in case of placenta percreta. Moreover, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada agree that screening for PAS disorders should be based on clinical risk factors along with sonographic findings. Regarding management, they all highlight the importance of a multidisciplinary team approach and recommend delivery by elective cesarean section at a tertiary center with experienced staff and appropriate resources. Routine preoperative ureteric stenting and occlusion of pelvic arteries are universally not recommended. Moreover, hysterectomy following the delivery of the fetus, expectant management with placenta left in situ, and conservative management in case of focal disease and desired fertility are all considered as acceptable treatment options. The reviewed guidelines also suggest some measures for intraoperative and postoperative hemorrhage control and recommend prophylactic administration of antibiotics. Methotrexate after expectant management is unanimously discouraged. On the other hand, there is no common pathway with regard to the optimal timing of delivery, the recommended mode of anesthesia, the preferred skin incision, and the effectiveness of the delayed hysterectomy approach.
UNASSIGNED: PAS disorders are mainly iatrogenic conditions with a constantly rising incidence and potentially devastating consequences for both the mother and the neonate. Thus, the development of uniform international practice protocols for effective screening, diagnosis, and management seems of paramount importance and will hopefully drive favorable pregnancy outcomes.
UNASSIGNED: The aim of this study was to review and compare the most recently published major guidelines on the diagnosis and management of this potentially life-threatening obstetric complication.
UNASSIGNED: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the International Society for Abnormally Invasive Placenta, the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada on PAS disorders was carried out.
UNASSIGNED: There is a consensus among the reviewed guidelines regarding the definition and the diagnosis of PAS using specific sonographic signs. In addition, they all agree that the use of magnetic resonance imaging should be limited to the evaluation of the extension to pelvic organs in case of placenta percreta. Moreover, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada agree that screening for PAS disorders should be based on clinical risk factors along with sonographic findings. Regarding management, they all highlight the importance of a multidisciplinary team approach and recommend delivery by elective cesarean section at a tertiary center with experienced staff and appropriate resources. Routine preoperative ureteric stenting and occlusion of pelvic arteries are universally not recommended. Moreover, hysterectomy following the delivery of the fetus, expectant management with placenta left in situ, and conservative management in case of focal disease and desired fertility are all considered as acceptable treatment options. The reviewed guidelines also suggest some measures for intraoperative and postoperative hemorrhage control and recommend prophylactic administration of antibiotics. Methotrexate after expectant management is unanimously discouraged. On the other hand, there is no common pathway with regard to the optimal timing of delivery, the recommended mode of anesthesia, the preferred skin incision, and the effectiveness of the delayed hysterectomy approach.
UNASSIGNED: PAS disorders are mainly iatrogenic conditions with a constantly rising incidence and potentially devastating consequences for both the mother and the neonate. Thus, the development of uniform international practice protocols for effective screening, diagnosis, and management seems of paramount importance and will hopefully drive favorable pregnancy outcomes.
摘要：
■胎盘植入谱（PAS）代表一系列以胎盘异常侵袭为特征的疾病，并与严重的孕产妇发病率和死亡率有关。
本研究的目的是回顾和比较最近发表的关于诊断和治疗这种潜在威胁生命的产科并发症的主要指南。
■对美国妇产科医师学会指南的描述性审查，澳大利亚和新西兰皇家妇产科学院，国际异常侵袭胎盘协会，皇家妇产科学院，国际妇产科联合会，和加拿大妇产科医师协会对PAS疾病进行了研究。
■关于使用特定超声征象的PAS的定义和诊断，所审查的指南之间存在共识。此外,他们都同意，磁共振成像的使用应仅限于在胎盘穿孔的情况下评估盆腔器官的延伸。此外，美国妇产科学院，皇家妇产科学院，国际妇产科联合会，加拿大妇产科医师协会同意,PAS疾病的筛查应基于临床危险因素和超声检查结果.关于管理，他们都强调了多学科团队方法的重要性，并建议在拥有经验丰富的员工和适当资源的三级中心进行选择性剖宫产分娩。普遍不建议常规术前输尿管支架置入术和盆腔动脉闭塞。此外，胎儿分娩后子宫切除术，胎盘留在原位的预期管理，在局灶性疾病和所需生育能力的情况下，保守管理都被认为是可接受的治疗选择。审查的指南还提出了一些术中和术后出血控制措施，并建议预防性使用抗生素。一致不鼓励预期管理后的甲氨蝶呤。另一方面,关于最佳交付时机没有共同的途径，推荐的麻醉模式，首选的皮肤切口，以及延迟子宫切除术方法的有效性。
PAS障碍主要是医源性疾病，发病率不断上升，对母亲和新生儿都有潜在的破坏性后果。因此，制定有效筛查的统一国际惯例协议，诊断,和管理似乎至关重要，有望推动良好的妊娠结局。
本研究的目的是回顾和比较最近发表的关于诊断和治疗这种潜在威胁生命的产科并发症的主要指南。
■对美国妇产科医师学会指南的描述性审查，澳大利亚和新西兰皇家妇产科学院，国际异常侵袭胎盘协会，皇家妇产科学院，国际妇产科联合会，和加拿大妇产科医师协会对PAS疾病进行了研究。
■关于使用特定超声征象的PAS的定义和诊断，所审查的指南之间存在共识。此外,他们都同意，磁共振成像的使用应仅限于在胎盘穿孔的情况下评估盆腔器官的延伸。此外，美国妇产科学院，皇家妇产科学院，国际妇产科联合会，加拿大妇产科医师协会同意,PAS疾病的筛查应基于临床危险因素和超声检查结果.关于管理，他们都强调了多学科团队方法的重要性，并建议在拥有经验丰富的员工和适当资源的三级中心进行选择性剖宫产分娩。普遍不建议常规术前输尿管支架置入术和盆腔动脉闭塞。此外，胎儿分娩后子宫切除术，胎盘留在原位的预期管理，在局灶性疾病和所需生育能力的情况下，保守管理都被认为是可接受的治疗选择。审查的指南还提出了一些术中和术后出血控制措施，并建议预防性使用抗生素。一致不鼓励预期管理后的甲氨蝶呤。另一方面,关于最佳交付时机没有共同的途径，推荐的麻醉模式，首选的皮肤切口，以及延迟子宫切除术方法的有效性。
PAS障碍主要是医源性疾病，发病率不断上升，对母亲和新生儿都有潜在的破坏性后果。因此，制定有效筛查的统一国际惯例协议，诊断,和管理似乎至关重要，有望推动良好的妊娠结局。
