Cal Margarida, Ayres-de-Campos Diogo, Jauniaux Eric
Department of Obstetrics and Gynecology, Santa Maria Hospital, Lisbon, Portugal.
Department of Obstetrics and Gynecology, Medical School, University of Lisbon, Lisbon, Portugal.
Int J Gynaecol Obstet. 2018 Mar;140(3):307-311. doi: 10.1002/ijgo.12391. Epub 2017 Dec 22.
To identify geographic differences in diagnostic and treatment practices during the perinatal management of placenta accreta spectrum (PAS) disorders.
An online survey was conducted from May 1 to August 1, 2017. The 18-item questionnaire was emailed to all members of the expert panel for the 2018 International Federation of Gynecology and Obstetrics consensus guidelines on PAS (n=34), as well as international experts who had contributed to the content of these guidelines (n=16).
Questionnaires were returned by 36 of the 50 experts (72% response rate). Most respondents were from Europe (n=22; 61%) or Asia (n=9; 25%). Despite large disparity in the number of patients with PAS disorders managed surgically or conservatively (range from 0 to >1000) and the different techniques used by the respondents, the screening and diagnostic methods used were similar, with transvaginal imaging used by 31 (86%) experts, and both ultrasonography and magnetic resonance imaging used by 22 (61%). In all, 22 (61%) experts indicated a preference for radical surgery, with primary cesarean hysterectomy leaving the placenta in situ reported as the most frequent approach (n=20; 55%).
Wide variation found in global PAS practices indicated a need for standardized data and an evidence-based approach to the diagnosis and management of PAS disorders.
确定胎盘植入谱系障碍（PAS）围产期管理中诊断和治疗方法的地域差异。
于2017年5月1日至8月1日进行了一项在线调查。这份包含18个条目的问卷通过电子邮件发送给了参与2018年国际妇产科联合会PAS共识指南制定的专家小组所有成员（n = 34）以及为这些指南内容做出贡献的国际专家（n = 16）。
50位专家中有36位回复了问卷（回复率为72%）。大多数受访者来自欧洲（n = 22；61%）或亚洲（n = 9；25%）。尽管在接受手术或保守治疗的PAS患者数量（范围从0至超过1000）以及受访者所采用的不同技术方面存在很大差异，但所使用的筛查和诊断方法相似，31位（86%）专家使用经阴道成像，22位（61%）专家同时使用超声检查和磁共振成像。共有22位（61%）专家表示倾向于根治性手术，原位保留胎盘的初次剖宫产子宫切除术被报告为最常用的方法（n = 20；55%）。
全球PAS诊疗实践中存在很大差异，这表明需要标准化数据以及基于证据的PAS疾病诊断和管理方法。
