Placenta accreta spectrum disorders: A Canadian tertiary care centre's experience over 10 years

Objectives: The placenta accreta spectrum disorders (PASD) are associated with significant maternal and neonatal morbidity and mortality worldwide. As cesarean delivery rates increase, so does the rate of PASD. PASD antepartum diagnosis and perioperative management are evolving, and we primarily aimed to share our tertiary care centre's institutional approach and outcomes over a decade.

Methods: A retrospective chart review of cesarean hysterectomy for suspected or confirmed PASD was conducted at a single tertiary centre in XXX from 2010 to 2021.

Results: A total of 46 records remained after the exclusion criteria, with a diagnosis of PASD in 94% of cases, 20% consistent with accreta, 48% with increta, and 26% with percreta. 41% of cesarean hysterectomies were done on an unscheduled emergency basis. All cases had antenatal ultrasound imaging, and 57% received an antenatal MRI. Prophylactic ureteric stenting occurred in 37% of cases. Mean total operative time was 97 minutes, and 50% of cases received an intra-operative blood transfusion. Ureteric injury occurred in 2% of cases, and admission to ICU in 13% of cases.

Conclusion: PASD is a complex and highly morbid condition. We have shared our institutional experience and explored some variations in practice including use of prophylactic ureteric stenting. Additional research is needed to further explore the optimal methods to diagnose and manage this complex disorder.