{
    "abstract": "Placenta accreta spectrum (PAS) can lead to major peripartum morbidity. Appropriate management approaches depend on the clinical severity, each individual's preference, and the treating team's expertise. Peripartum hysterectomy is the most frequently used treatment option. However, it can impact psychological well-being and fertility. We investigated whether conservative treatment with focal resection or leaving the placenta in\u00a0situ is associated with comparable or lower maternal morbidity than hysterectomy in centers of excellence within the International Society for placenta accreta spectrum (IS-PAS). Furthermore, a survey was conducted to explore potential barriers to conservative management in antenatal counseling and intraoperative decision-making.\nConfirmed PAS cases in the prospective IS-PAS database from 22 registered centers between January 2020 and June 2022 were included in the analysis. A separate online survey with 21 questions was answered by the IS-PAS center experts about indications, diagnostic criteria, patient counseling, surgical practice, changes from the preoperative treatment plan, and why conservative management may not be offered.\nA total of 234 cases were included in the analysis: 186 women received hysterectomy and 38 women were treated by focal resection, and 10 by leaving the placenta in\u00a0situ. Blood loss was lower in the focal resection group and in the placenta in\u00a0situ group compared to the hysterectomy group (p\u2009=\u20090.04). 46.4% of the women initially planned for focal resection, and 35.7% of those initially planned for leaving the placenta in\u00a0situ were ultimately treated by hysterectomy. Our survey showed that the IS-PAS centers preferred hysterectomy according to a woman's wishes (64%) and when they expected less blood loss and morbidity (41%). Eighteen percent of centers did not offer focal resection at all due to a lack of experience with this technique. Reasons for not offering to leave the placenta in\u00a0situ were avoidance of unexpected reoperation (36%), puerperal infection (32%), or skepticism about the method (23%).\nUterus-preserving treatment strategies such as focal resection appear to be safe alternatives to peripartum hysterectomy. However, less than half of the IS-PAS centers perform them. Acceptance of conservative treatments could be increased by standardized criteria for their implementation and by systematic training for PAS experts.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany.",
            "firstname": "Alexander",
            "initials": "A",
            "lastname": "Paping"
        },
        {
            "affiliation": "Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Dresden, Germany.",
            "firstname": "Anja",
            "initials": "A",
            "lastname": "Bluth"
        },
        {
            "affiliation": "Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital Frankfurt Goethe-University, Frankfurt am Main, Germany.\nDepartment of Obstetrics and Gynecology, Buerger Hospital, Frankfurt, Germany.",
            "firstname": "Ammar",
            "initials": "A",
            "lastname": "Al Naimi"
        },
        {
            "affiliation": "Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium.",
            "firstname": "Mina",
            "initials": "M",
            "lastname": "Mhallem"
        },
        {
            "affiliation": "Department of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland.",
            "firstname": "Magdalena",
            "initials": "M",
            "lastname": "Kolak"
        },
        {
            "affiliation": "Department of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland.",
            "firstname": "Andrzej",
            "initials": "A",
            "lastname": "Jaworowski"
        },
        {
            "affiliation": "Department of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland.",
            "firstname": "Hubert",
            "initials": "H",
            "lastname": "Huras"
        },
        {
            "affiliation": "Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \"Luigi Vanvitelli\", Naples, Italy.\nDepartment of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.",
            "firstname": "Maddalena",
            "initials": "M",
            "lastname": "Morlando"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.",
            "firstname": "George",
            "initials": "G",
            "lastname": "Daskalakis"
        },
        {
            "affiliation": "Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o, Departamento de Ginecologia, Porto, Portugal.",
            "firstname": "Pedro Viana",
            "initials": "PV",
            "lastname": "Pinto"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France.",
            "firstname": "Lo\u00efc",
            "initials": "L",
            "lastname": "Sentilhes"
        },
        {
            "affiliation": "Department of Gynecological Oncology, Erasmus MC Cancer Center, Rotterdam, The Netherlands.",
            "firstname": "Heleen J",
            "initials": "HJ",
            "lastname": "van Beekhuizen"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.",
            "firstname": "Vedran",
            "initials": "V",
            "lastname": "Stefanovic"
        },
        {
            "affiliation": "Division of Maternal-Fetal Medicine, Department of OB-GYN, Baylor College of Medicine, Houston, Texas, USA.",
            "firstname": "Karin A",
            "initials": "KA",
            "lastname": "Fox"
        },
        {
            "affiliation": "Universit\u00e9 de Lorraine, CHRU-NANCY, P\u00f4le de la Femme, and Universit\u00e9 de Lorraine, Inserm, IADI, Nancy, France.",
            "firstname": "Olivier",
            "initials": "O",
            "lastname": "Morel"
        },
        {
            "affiliation": "Universit\u00e9 de Lorraine, CHRU-NANCY, P\u00f4le de la Femme, and Universit\u00e9 de Lorraine, Inserm, IADI, Nancy, France.",
            "firstname": "Charline",
            "initials": "C",
            "lastname": "Bertholdt"
        },
        {
            "affiliation": "Department of Obstetrics, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany.",
            "firstname": "Thorsten",
            "initials": "T",
            "lastname": "Braun"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).",
    "doi": "10.1111/aogs.14855",
    "journal": "Acta obstetricia et gynecologica Scandinavica",
    "keywords": [
        "abnormally invasive placenta",
        "cesarean",
        "high\u2010risk pregnancy",
        "hysterectomy",
        "placenta",
        "surgical techniques",
        "uterine scar"
    ],
    "methods": null,
    "publication_date": "2024-05-02",
    "pubmed_id": "38695676",
    "results": "A total of 234 cases were included in the analysis: 186 women received hysterectomy and 38 women were treated by focal resection, and 10 by leaving the placenta in\u00a0situ. Blood loss was lower in the focal resection group and in the placenta in\u00a0situ group compared to the hysterectomy group (p\u2009=\u20090.04). 46.4% of the women initially planned for focal resection, and 35.7% of those initially planned for leaving the placenta in\u00a0situ were ultimately treated by hysterectomy. Our survey showed that the IS-PAS centers preferred hysterectomy according to a woman's wishes (64%) and when they expected less blood loss and morbidity (41%). Eighteen percent of centers did not offer focal resection at all due to a lack of experience with this technique. Reasons for not offering to leave the placenta in\u00a0situ were avoidance of unexpected reoperation (36%), puerperal infection (32%), or skepticism about the method (23%).",
    "title": "Opportunities for, and barriers to, uterus-preserving surgical techniques for placenta accreta spectrum.",
    "xml": "<Element 'PubmedArticle' at 0x78850476d800>"
}