EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt.
Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:75-88. doi: 10.1016/j.bpobgyn.2019.04.006. Epub 2019 Apr 30.
The increasing incidence of caesarean delivery (CD) has resulted in an increase in placenta accreta spectrum (PAS), adversely impacting maternal outcomes globally. Currently, more than 90% of women diagnosed with PAS present with a placenta praevia (praevia PAS). Praevia PAS can be reliably diagnosed antenatally with ultrasound, and it is unclear whether magnetic resonance imaging improves diagnosis beyond what can be achieved by skilled ultrasound operators. Therefore, any screening programme for PAS will require improved training in the diagnosis of placental disorders and development of targeted scanning protocols. Management strategies for praevia PAS vary depending on the accuracy of prenatal diagnosis, findings at laparotomy and local surgical expertise. Current epidemiological data for PAS are highly heterogeneous, mainly due to wide variation in the clinical criteria used to diagnose the condition at birth. This significantly impacts research into all aspects of the condition, especially comparison of the efficacy of different management strategies.
剖宫产率的上升导致胎盘植入谱系(PAS)的发病率增加,对全球产妇结局产生不利影响。目前,超过 90%的 PAS 诊断患者表现为前置胎盘(前置胎盘 PAS)。前置胎盘 PAS 可以通过超声可靠地在产前诊断,目前尚不清楚磁共振成像是否能在熟练的超声操作人员所能达到的诊断水平上有所提高。因此,任何 PAS 的筛查方案都需要提高对胎盘疾病诊断的培训,并制定有针对性的扫描方案。前置胎盘 PAS 的管理策略因产前诊断的准确性、剖腹术时的发现和当地的手术专业知识而异。目前 PAS 的流行病学数据高度异质,主要是由于用于在分娩时诊断 PAS 的临床标准存在广泛差异。这对 PAS 各个方面的研究都产生了重大影响,尤其是不同管理策略的疗效比较。