Management of Placenta Accreta Spectrum Disorders
No Thumbnail Available
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Placenta accreta spektra (PAS) traucējumi raksturo slimību grupu, kurā placenta ir patoloģiski ieaugusi dzemdes sieniņā vai serozā un, iespējams, blakus esošajos iegurņa orgānos. PAS traucējumi ir iedalīti trīs variantos: placenta accreta, increta un percreta, pamatojoties uz trofoblastiskās invāzijas dziļumu. Placentas accreta spektra traucējumu sastopamība pieaug, jo palielinās ķeizargriezienu skaits, padarot to par mūsu laika jatrogēnu problēmu. Ārstēšanas metodes var iedalīt radikālās un konservatīvās. Radikālās metodes ietver primāro histerektomiju tūlīt pēc zīdaiņa piedzimšanas vai aizkavētu histerektomiju dažas dienas vai nedēļas pēc dzemdībām. Histerektomija pašlaik joprojām ir standarta ārstēšanas iespēja, tomēr arvien vairāk parādās konservatīvākas metodes, kuru mērķis ir saglabāt auglību un samazināt komplikācijas, kas varētu rasties no histerektomijas. Konservatīvās metodes, īpaši miometrija rezekcijas metodes, kļūst arvien populārākas, un vairāki autori ir aprakstījuši to panākumus, īpaši placenta percreta gadījumos. Tomēr mums trūkst vispārīgu vadlīniju ārstēšanas taktikas izvēlē, tāpēc biežāk slimnīcām vai klīnikām ir savas pieejas un metodes atkarībā no zināšanām un prasmēm. Pierādījumi par dažādām metodēm ir zemas kvalitātes, jo ir ļoti maz publicētu randomizēti kontrolētu pētījumu. Turklāt pētniecība šajā jomā saskaras ar ētisku izaicinājumu: mums ir nepieciešams vairāk pētījumu, lai pieņemtu labākus lēmumus par PAS traucējumu ārstēšanu, taču randomizētu kontrolētu pētījumu veikšana, iesaistot pacientes ar šo traucējumu, var būt nosodāma, jo tā var potenciāli apdraudēt mātes un/vai jaundzimušā dzīvību. Šajā literatūras apskatā ir apskatītas dažādas radikālas un konservatīvas ārstēšanas iespējas, kas pašlaik ir pieejamas vai ieteiktas PAS traucējumiem. Papildus tiek apspriesta PAS traucējumu diagnostika, aspekti, kas jāņem vērā pirms dzemdībām, dažādas asins saglabāšanas metodes un komplikācijas.
Placenta accreta spectrum (PAS) disorders describe a group of diseases in which the placenta is abnormally adherent or invades the uterine serosa and possibly adjacent pelvic organs. PAS disorders are classified into three variants: placenta accreta, increta and percreta, based on the depth of the trophoblastic growth. The incidence of placenta accreta spectrum disorders is increasing due to the increased rate of cesarean deliveries, making it essentially an iatrogenic disorder of our time. The management techniques can be divided into radical and conservative methods. The radical methods include primary hysterectomy immediately after the delivery of the infant or a delayed hysterectomy some days or weeks after the delivery. Hysterectomy remains currently still as the standard treatment option however more and more conservative methods are arising which aim to preserve fertility and to decrease complications which might arise from hysterectomy. The conservative methods especially the myometrial resective techniques are getting more popular and multiple authors have described their success especially with placenta percreta cases. However, we lack generalized guidelines for the management and thus it is more common to see hospitals or clinics to have their own approaches and techniques depending on the expertise and preference. Evidence on the management techniques is of low quality since there are barely randomized controlled trials published. Furthermore, research in this field faces an ethical challenge; we need more research to make better decisions regarding the treatment of PAS disorder but conducting randomized controlled trials including patients with this disorder may be reprehensible, since it can put the life of the mother and/or newborn at potential risk. In this literature review different radical and conservative management options, which are currently available or suggested for PAS disorders, are reviewed. In addition, diagnosing the PAS disorder, aspects to consider before the delivery, different blood conservation techniques and complications are discussed.
Placenta accreta spectrum (PAS) disorders describe a group of diseases in which the placenta is abnormally adherent or invades the uterine serosa and possibly adjacent pelvic organs. PAS disorders are classified into three variants: placenta accreta, increta and percreta, based on the depth of the trophoblastic growth. The incidence of placenta accreta spectrum disorders is increasing due to the increased rate of cesarean deliveries, making it essentially an iatrogenic disorder of our time. The management techniques can be divided into radical and conservative methods. The radical methods include primary hysterectomy immediately after the delivery of the infant or a delayed hysterectomy some days or weeks after the delivery. Hysterectomy remains currently still as the standard treatment option however more and more conservative methods are arising which aim to preserve fertility and to decrease complications which might arise from hysterectomy. The conservative methods especially the myometrial resective techniques are getting more popular and multiple authors have described their success especially with placenta percreta cases. However, we lack generalized guidelines for the management and thus it is more common to see hospitals or clinics to have their own approaches and techniques depending on the expertise and preference. Evidence on the management techniques is of low quality since there are barely randomized controlled trials published. Furthermore, research in this field faces an ethical challenge; we need more research to make better decisions regarding the treatment of PAS disorder but conducting randomized controlled trials including patients with this disorder may be reprehensible, since it can put the life of the mother and/or newborn at potential risk. In this literature review different radical and conservative management options, which are currently available or suggested for PAS disorders, are reviewed. In addition, diagnosing the PAS disorder, aspects to consider before the delivery, different blood conservation techniques and complications are discussed.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Placenta accreta spektra traucējumu ārstēšanas iespējas, placenta accreta spektra traucējumu radikālas ķirurģiskas ārstēšanas metodes, placenta accreta spektra traucējumu konservatīvas ārstēšanas metodes, jaunas placenta accreta spektra traucējumu ārstēšanas metodes, Management of placenta accreta spectrum disorders, radical surgical management techniques for placenta accreta spectrum disorders, conservative management techniques for placenta accreta spectrum disorders, novel management techniques for placenta accreta spectrum disorders