Risk factors, Diagnosis and Outcomes of Management Strategies of Placenta Accreta Spectrum (PAS) Disorders in Low-resources Settings: Case Report

Haidarotul Milla, Syauqi Kashira Yoshi Akhmadi, Fennisia Wibisono, Flori R Sari

Abstract


Background: Placenta accreta spectrum disorder (PAS), such as placenta accreta, placenta increta, and placenta percreta are causes of post-partum hemorrhage causing maternal morbidity and mortality. The major risk issues are prior caesarean section, placenta previa, advanced maternal age, multiparity, and preeclampsia. A reliable antenatal diagnosis is required for this serious condition. To reduce the incidence of maternal morbidity and mortality due to massive bleeding, it is necessary to make an early diagnosis in order for the surgical approach can be planned in the future. High birth rates and cesarean delivery are the cause of an increase in the incidence of PAS in middle / low-income countries. Additional diagnostic methods, advanced surgical methods, and other interventional radiological methods can greatly contribute to reducing maternal morbidity and mortality in high-income countries but are frequently not available in low-resource settings. Therefore, an inexpensive management strategy is an important issue.

Methods: This is a retrospective case series. The patients suspected of PAS are reassessed histologically for the diagnosis confirmation. The information about risk factors, time to decide a definite diagnosis, monitoring vital signs, resuscitation, blood transfusions, surgical management, and maternal outcomes are detailed in a table.

Result: We reported five women with PAS, diagnosed and managed in our hospital, with different conditions at admission and a different risk factor for PAS. All of the patients undergoing subtotal hysterectomy and uterine tissue samples were sent to the anatomical pathology department for histopathological examination. Red blood cell transfusions were used in all patients and transfer of patients to the intensive care unit was carried out postoperatively. Complications related to monitoring occurred in one patient such as acute kidney injury. There was one maternal death that occurred.

Conclusion: Antenatal diagnosis is essential in outlining the best management strategy in patients with PAS. The clinical approach was able to prove valuable when PAS is suspected before delivery. In low-resource settings, lack of interventional radiology services and prenatal diagnostic may probably impact patients management with PAS.

International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 503-509


Keywords


placenta accreta spectrum, abnormal placentation, PAS

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DOI: http://dx.doi.org/10.31344/ijhhs.v5i4.364

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