THE MANAGEMENT STRATEGIES IN THE PLACENTA ACCRETA SPECTRUM IN TERTIARY CENTERS IN TÜRKİYE

Year 2024, Volume: 87 Issue: 1, 43 - 53, 29.01.2024

Selim Büyükkurt , Rauf Melekoğlu , İrem Hatipoğlu

https://doi.org/10.26650/IUITFD.1351897

Abstract

Objective: To determine the differences and consensus points in managing patients with placenta accreta spectrum (PAS) disorder in a nationwide survey.
Material and Method: Forty-seven items were asked via an online survey. Seventy-seven percent responded to the survey (37/48). Consensus/strong consensus was predefined as 75%– 89% (28–33/37)/>90% (≥34/37) of panelists agreeing on an answer.
Result: In a few areas, consensus or strong consensus was achieved. These are the absence of interventional radiology (89.2%) and cell-saver in the institution (94.6%), a rare selection of magnetic resonance (83.8%), and frequent use of transvaginal sonography (94.6%) as an adjuvant diagnostic tool. Penetrative sexual intercourse is prohibited (78.4%); perineal shaving (81.1%) and rectal enema (94.6%) are not used; general anesthesia (75.7%) is the preferred technique; hypothermia control (97.3%) is not omitted; and administration of oxytocin (75.7%) is similar to routine cesarean section; vascular injuries are managed by vascular surgeons (78.4%); gynecologic oncologists are not a regular part of the surgical team (86.5%); routine insertion of a central venous cannula (78.4%) is not considered and placement of an abdominal drain (89.2%) is usually performed. Surgery is often performed through a median abdominal incision (83.8%), and a total hysterectomy (81.1%) is chosen. Routine hypogastric artery ligation (91.9%) is not performed. In the postoperative period, the patients are allowed to have early mobilization (91.9%) and oral intake (83.8%). They are habitually discharged on the 3rd-4th postoperative day (75.7%). Psychiatric needs are often neglected (94.6%).
Conclusion: These consensus points could help obstetricians manage this complicated condition. These results also demonstrate the need for evidence-based data for implementing proper treatment strategies for PAS disorder. Future research is sought for these points.

Keywords

Perinatology, placenta accreta, postpartum hemorrhage, surveys and questionnaires

TÜRKİYE'DEKİ ÜÇÜNCÜL MERKEZLERDE PLASENTA AKRETA SPEKTRUMUNUN YÖNETİM STRATEJİLERİ

Abstract

Amaç: Plasenta akreta spektrumunun (PAS) yönetimindeki ortak ve farklı yaklaşımların ulusal çapta bir anket çalışmasıyla belirlenmesi.
Gereç ve Yöntem: Çevrim içi bir anket ile 47 soru yöneltildi. Katılımcıların %77’si ankete cevap verdi (37/48). Katılımcıların cevaplarında uyum için %75-89 (28–33/37), kuvvetli uyum için ≥ %90 (≥34/37) fikir birliği arandı.
Bulgular: Az sayıda konuda uyum ve kuvvetli uyum sağlanabildi. Bunlar girişimsel radyoloji imkânı olmaması (%89,2), hücre kurtarıcı olmaması (%94,6), manyetik rezonansın nadiren kullanılması (%83,8), yardımcı görüntüleme yöntemi olarak sıklıkla transvajinal sonografi (%94,6) kullanılmasıdır. Penetran cinsel ilişkinin yasaklanması (%78,4), perine traşı (%81,1) ve lavman kullanılmaması (%94,6), genel anestezi kullanılması (%75,7), hipotermi kontrolünün ihmal edilmemesi (%97,3), oksitosinin sezaryende kullanılan dozda uygulanması (%75,7), damar yaralanmalarında damar cerrahisinden yardım alınması (%78,4), jinekolojik onkoloji uzmanlarının ameliyatlara rutin olarak çağrılmaması (%86,5), santral venöz kateterin rutin olarak rutin olarak takılmaması (%78,4) ve ameliyat bitiminde genellikle dren konulması (%89,2) ise diğer noktalardır. Katılımcılar arasında insizyon tercihi genellikle orta hat kesidir (%83,8) ve ameliyat şekli total histerektomidir (%81,1). Ameliyat sonrası dönemde hastaların hareket etmesi (%91,9) ve beslenmesi (%83,8) kısıtlanmamaktadır. Genellikle ameliyat sonrası 3.-4. günlerde taburcu edilmelerine (%75,7) karar verilmektedir. Psikiyatrik ihtiyaçları genellikle ihmal edilmektedir (%94,6).
Sonuç: Görüş birliği elde edilen noktalar bu karmaşık sorunun yönetiminde doğum hekimlerine yardımcı olabilir. Bu sonuçlar aynı zamanda PAS’ın doğru yönetimi için kanıta dayalı bilgi açığını ortaya koymaktadır. Bu konular için gelecekte yapılacak çalışmalara ihtiyaç vardır.

Keywords

Perinatoloji, plasenta akreta, postpartum kanama, anket

References

• 1. Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019;220(6):511-26. [CrossRef] google scholar
• 2. Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015;212(5):561-8. [CrossRef] google scholar
• 3. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA 2015;313(5):471-82. [CrossRef] google scholar
• 4. Liu Y, Li X, Che X, Zhao G, Xu M. Intraoperative cell salvage for obstetrics: a prospective randomized controlled clinical trial. BMC Pregnancy Childbirth 2020;20(1):452. [CrossRef] google scholar
• 5. Faralli I, Del Negro V, Chine A, Aleksa N, Ciminello E, Piccioni MG. Placenta Accreta Spectrum (PAS) disorder: Ultrasound versus magnetic resonance imaging. Diagnostics (Basel) 2022;12(11):2769. [CrossRef] google scholar
• 6. Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine Obstetric Care consensus no. 7: Placenta accreta spectrum. Obstet Gynecol 2018;132(6):e259-75. [CrossRef] google scholar
• 7. Pacheco LD, Gei AF. Controversies in the management of placenta accreta. Obstet Gynecol Clin North Am 2011;38(2):313-22. [CrossRef] google scholar
• 8. Cal M, Ayres-de-Campos D, Jauniaux E. International survey of practices used in the diagnosis and management of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2018;140(3):307-11. [CrossRef] google scholar
• 9. Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL, et al. Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. J Matern Fetal Neonatal Med 2013;26(16):1602-9. [CrossRef] google scholar
• 10. Jolley JA, Nageotte MP, Wing DA, Shrivastava VK. Management of placenta accreta: a survey of maternal-fetal Medicine practitioners. J Matern Fetal Neonatal Med 2012;25(6):756-60. [CrossRef] google scholar
• 11. Esakoff TF, Handler SJ, Granados JM, Caughey AB. PAMUS: placenta accreta management across the United States. J Matern Fetal Neonatal Med 2012;25(6):761-5. [CrossRef] google scholar
• 12. Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand 2016;60(4):457-64. [CrossRef] google scholar
• 13. Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD. Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids: A systematic review and meta-analysis. JAMA Pediatr 2022;176(6):e220483. [CrossRef] google scholar
• 14. Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019;221(1):19-29.e3. [CrossRef] google scholar
• 15. Kabiri D, Hants Y, Shanwetter N, Simons M, Weiniger CF, Gielchinsky Y, et al. Outcomes of subsequent pregnancies after conservative treatment for placenta accreta. Int J Gynaecol Obstet 2014;127(2):206-10. [CrossRef] google scholar
• 16. Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Effects of obstetric interventions during labor on birth process and newborn health. Florence Nightingale J Nurs 2021;29(1):9-21. [CrossRef] google scholar
• 17. MacPhedran SE. Sexual activity recommendations in high-risk pregnancies: What is the evidence? Sex Med Rev 2018;6(3):343-57. [CrossRef] google scholar
• 18. Ghaleb MM, Safwat S, Purohit R, Samy M. Conservative stepwise surgical approach for management of placenta previa accreta: A prospective case series study. Int J Gynaecol Obstet 2022;157(2):383-90. [CrossRef] google scholar
• 19. Buyukkurt S, Sucu M, Hatipoglu I, Ozlu F, Unlugenc H, Evruke C, et al. Placenta accreta spectrum surgery with the Joel Cohen incision for abdominal access: a single-center experience. Ginekol Pol 2023;94(7):532-8. [CrossRef] google scholar
• 20. Celik S, Celik H, Soyer Caliskan C, Tosun M, Hatirnaz S. Bladder filling before accreta surgery is a very effective method for preventing bladder injury: a retrospective cohort study. J Matern Fetal Neonatal Med 2021;34(3):2206-11. [CrossRef] google scholar
• 21. Turan OM, Shannon A, Asoglu MR, Goetzinger KR. A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder. J Matern Fetal Neonatal Med 2021;34(13):2061-70. [CrossRef] google scholar
• 22. ACOG Practice Bulletin No. 199: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2018;132(3):e103-19. [CrossRef] google scholar
• 23. Wolfhagen N, Boldingh QJJ, de Lange M, Boermeester MA, de Jonge SW. Intraoperative redosing of surgical antibiotic prophylaxis in addition to preoperative prophylaxis versus single-dose prophylaxis for the prevention of surgical site infection. Ann Surg 2022;275(6):1050-7. [CrossRef] google scholar
• 24. Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section--pilot study. ISRCTN 40302163. Eur J Obstet Gynecol Reprod Biol 2009;142(1):30-3. [CrossRef] google scholar
• 25. Szczepanska-Sadowska E. The heart as a target of vasopressin and other cardiovascular peptides in health and cardiovascular diseases. Int J Mol Sci 2022;23(22):14414. [CrossRef] google scholar
• 26. Wikkels0 A, Wetterslev J, M0İler AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev 2016;2016(8):CD007871. [CrossRef] google scholar
• 27. Oden TN, Doruker NC, Korkmaz FD. Compliance of health professionals for prevention of inadvertent perioperative hypothermia in adult patients: A review. AANA J 2022;90(4):281-7. google scholar
• 28. Lara-Canton I, Badurdeen S, Dekker J, Davis P, Roberts C, te Pas A, et al. Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping. Pediatr Res 2022. doi: 10.1038/s41390-021-01805-y [CrossRef] google scholar
• 29. Lau CQ, Wong TC, Tan EL, Kanagalingam D. A review of caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital. Singapore Med J 2017;58(6):327-31. [CrossRef] google scholar
• 30. Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, et al. Guidelines for postoperative care in cesarean delivery: Enhanced recovery after surgery (ERAS) society recommendations (part 3). Am J Obstet Gynecol 2019;221(3):247.e1-247.e9. [CrossRef] google scholar
• 31. Bartels HC, Mulligan KM, Lalor JG, Higgins MF, Brennan DJ. A life changing experience: An interpretative phenomenological analysis of women’s experiences of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol 2020;254:102-8. [CrossRef] google scholar