Rath Sudhanshu K, Das Asima, Mohini Mohini
Obstetrics and Gynaecology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2025 Mar 31;17(3):e81551. doi: 10.7759/cureus.81551. eCollection 2025 Mar.
The placenta accreta spectrum (PAS) was previously called the morbidly adherent placenta. It involves a range of pathological adherence of the placenta, including placenta increta, placenta percreta and placenta accreta, depending on the depth of invasion of anchoring villi into the myometrium and beyond. This spectrum of disorder is becoming a frequently encountered problem as a consequence of rising caesarean rates all over the world. Hysterectomy during caesarean delivery (CD) has been the conventional management of PAS. However, associated complications have prompted conservative surgery at the first sitting, with or without interventional radiology. The aim is to reduce blood loss and conserve the uterus if possible. It was decided to review the available literature on this emerging topic. Using PubMed and Google Scholar, our search focused on articles published from 2004 onwards, utilizing search terms "Placenta Accreta Spectrum" OR "Adherent Placenta" and "Caesarean Delivery". The selection for review adhered to specified inclusion/exclusion criteria and finally focused on 50 articles. It was found that published work includes the following conservative approaches: first, to leave the placenta expecting autolysis and resolution; second, to leave the placenta with the intention of a delayed hysterectomy; and third, to resort to an intraoperative arterial occlusion and follow-up. Though the primary objective of reducing blood loss at initial surgery is usually achieved, the success of uterine preservation differs. The availability of a multidisciplinary team for the surgical management of PAS is an important factor to consider. Limiting the extent of surgery at the time of CD, combined with or without arterial embolization/ballooning/ligation, reduces blood loss and limits morbidity with the potential to preserve the uterus.
胎盘植入谱系（PAS）以前被称为胎盘粘连异常。它涉及一系列胎盘的病理性粘连，包括胎盘植入、穿透性胎盘植入和粘连性胎盘植入，这取决于固定绒毛侵入子宫肌层及更深层的程度。由于全球剖宫产率的上升，这种疾病谱系正成为一个经常遇到的问题。剖宫产时行子宫切除术一直是PAS的传统治疗方法。然而，相关并发症促使在首次手术时采取保守手术，可联合或不联合介入放射学方法。目的是减少失血并尽可能保留子宫。因此决定对关于这个新出现话题的现有文献进行综述。利用PubMed和谷歌学术，我们的搜索集中在2004年以后发表的文章，使用的搜索词为“胎盘植入谱系”或“粘连性胎盘”以及“剖宫产”。纳入综述的文章遵循特定的纳入/排除标准，最终聚焦于50篇文章。结果发现，已发表的研究包括以下保守方法：第一，让胎盘自行溶解和消退；第二，保留胎盘以期进行延迟子宫切除术；第三，采用术中动脉闭塞并进行随访。虽然通常能在初次手术时实现减少失血的主要目标，但子宫保留的成功率有所不同。组建多学科团队对PAS进行手术管理是一个需要考虑的重要因素。在剖宫产时限制手术范围，联合或不联合动脉栓塞/球囊扩张/结扎，可减少失血并降低发病率，同时有可能保留子宫。
