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. 2021 Sep;43(9):713-723.
doi: 10.1055/s-0041-1736371. Epub 2021 Oct 20.

Management of placenta accreta spectrum

Álvaro Luiz Lage Alves  1 , Lucas Barbosa da Silva  2 , Fabrício da Silva Costa  3 , Guilherme de Castro Rezende  4
Affiliations

Management of placenta accreta spectrum

Álvaro Luiz Lage Alves et al. Rev Bras Ginecol Obstet. 2021 Sep.
No abstract available

PubMed Disclaimer

Conflict of interest statement

None to declare.

Figures

Figure 1.
Figure 1.
Grayscale ultrasound showing intraplacental hypoechoic images in the lower and anterior uterine segment compatible with placental lacunae in placenta previa accrete
Figure 2.
Figure 2.
Cross-section of the uterovesical surface performed transvaginally with B-mode associated with color Doppler showing bridging vessels between placenta and bladder
Figure 3.
Figure 3.
Three-dimensional rendered view of intraplacental hypervascularity associated with power Doppler
Figure 4.
Figure 4.
Multiplanar 3D representation of the placenta and uterovesical interface associated with power Doppler, showing uterovesical and intraplacental hypervascularity
Figure 5.
Figure 5.
Sagittal diagram of the division of S1 and S2 genital vascular regions. Source: Illustration by Felipe Lage Starling (authorized), 2021.
Figure 6.
Figure 6.
Vesicouterine, vesicoplacental and colpouterine anastomotic systems. Source: Illustration by Felipe Lage Starling (authorized), 2021. *Vesicouterine and vesicoplacental anastomotic systems. ** Colpouterine anastomotic system
Figure 7.
Figure 7.
Low selective ligations of vascular neoformations present in the uterine segment in the surgical management of placenta accreta. Exposure of vascular neoformations present in the vesicouterine reflection by means of traction with Allis forceps. Double ligations made using a suture passer
Figure 8.
Figure 8.
Excision with uteroplacental segmental exeresis followed by restoration of the uterine anatomy in conservative surgical treatment of placenta accreta. Upper left – excision of the uterine segment affected by invasion of placental cotyledons and ovular membranes. Other images – final aspects of the restoration of the uterine anatomy with hysterorrhaphy in the fundus or uterine body and suture between the uterine body and the residual lower uterine segment
Figure 9.
Figure 9.
Steps of the cesarean-hysterectomy technique in the surgical management of placenta accreta
Figure 10.
Figure 10.
Non-conservative surgical treatment of placenta accreta. Final aspects of uteri removed with placentas in situ in cesarean-hysterectomy
Figure 11.
Figure 11.
Bladder mobilization and dissection (Pelosi bypass) performed in the areas of vesicouterine adhesions in the surgical treatment of placenta accreta. Green arrows - after performing low selective ligations of vascular neoformations, mobilization and blunt dissection of the vesicouterine space are performed
Figure 12.
Figure 12.
Uterine compression sutures of Cho (adapted by Palacios-Jaraquemada), Dedes and Ziogas and segment transverse sutures in multiples of eight. Source: Illustration by Felipe Lage Starling (authorized), 2021.
Figure 13.
Figure 13.
Cho's uterine compression suture, uterine balloon tamponade and uterine sandwich technique. Source: Illustration by Felipe Lage Starling (authorized), 2021.
Figure 14.
Figure 14.
Placenta previa percreta implanted in the iliac vessels. Green arrows - placental tissue and vascular neoformations implanted over the right iliac vessels
See this image and copyright information in PMC

References

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    1. American College of Obstetricians and Gynecologists ; Society for Maternal-Fetal Medicine . Obstetric Care Consensus No. 7: placenta accreta spectrum. Obstet Gynecol. 2018;132(06):e259–75. doi: 10.1097/AOG.0000000000002983. - DOI - PubMed
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    1. Palacios-Jaraquemada J M. How to reduce the incidence of placenta accreta spectrum independently of the number of cesarean? Matern Fetal Med. 2019;1(02):68–9. doi: 10.1097/FM9.0000000000000020. - DOI

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