EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Best Pract Res Clin Obstet Gynaecol. 2021 Apr;72:102-116. doi: 10.1016/j.bpobgyn.2020.06.007. Epub 2020 Jun 27.
Accreta placentation and in particular its invasive forms are impacting maternal health outcomes globally and the prevalence of placenta accreta spectrum (PAS) continues to increase. The Royal College of Obstetricians and Gynaecologists (RCOG) and the American College of Obstetricians and Gynecologists (ACOG) with the Society for Maternal-Fetal Medicine (SMFM) have updated their national guidelines, whereas the Federation International of Gynecology and Obstetrics (FIGO) and the Society of Obstetricians and Gynecologists of Canada (SOGC) have developed new guidelines on the diagnosis and management of PAS. A comparison of these guidelines highlights common strong recommendations on the need to carefully evaluate women at high risk for PAS (e.g. prior uterine surgery presenting with anterior low-lying placenta or placenta previa), using multi-modal ultrasound imaging. For women diagnosed with PAS, multidisciplinary team-based care, with full logistic support structures (immediate access to comprehensive blood products, adult and neonatal intensive care) and established expertise in complex pelvic surgery, is critical to maximise safe outcomes for mothers and newborns.
胎盘植入，特别是其侵袭性形式，正在对全球产妇健康结果产生影响，胎盘植入疾病谱（PAS）的患病率持续上升。皇家妇产科医师学院（RCOG）、美国妇产科医师学会（ACOG）和母胎医学学会（SMFM）更新了其国家指南，而国际妇产科联合会（FIGO）和加拿大妇产科医师学会（SOGC）则制定了 PAS 诊断和管理的新指南。对这些指南的比较突出了对高危 PAS 女性（例如既往子宫手术、前置胎盘或胎盘前置且胎盘位置较低）进行仔细评估的共同强烈建议，使用多模态超声成像。对于诊断为 PAS 的女性，多学科团队的护理，以及全面的后勤支持结构（即时获得全面的血液制品、成人和新生儿重症监护）和复杂骨盆手术的专业知识，对于最大限度地确保母婴安全结果至关重要。
