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Placenta Previa-Accreta Management Algorithm

Multidisciplinary management approach for life-threatening obstetric haemorrhage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Placenta Previa-Accreta Management Algorithm?

Placenta previa is the implantation of the placenta partially or fully covering the internal cervical os; placenta accreta spectrum (PAS) defines abnormal placental adherence (accreta), invasion (increta) or full transmural penetration (percreta) into the uterine wall. The risk increases with the number of previous caesarean sections and accompanying placenta previa.

Diagnosis is supported by transabdominal/transvaginal ultrasonography and Doppler from 18-20 weeks; in suspicious cases, MRI is used in the third trimester. PAS findings include placental lacunae, loss of clear zone, hypervascularity at the bladder-uterus interface and loss of the retroplacental clear space.

Management requires planned caesarean hysterectomy at 34-36 weeks at a tertiary centre with a multidisciplinary team (gynaecologic oncologist, urologist, anaesthetist, interventional radiologist, blood bank). In selected cases, conservative options (uterine preservation, leaving the placenta in situ) and prophylactic balloon occlusion of the iliac arteries may be considered. The risk of massive haemorrhage and intensive care requirement is high.

Symptoms

Painless vaginal bleeding in the second-third trimester
Bright red bleeding
Recurrent bleeding episodes
Diagnosis on routine ultrasound
Foetal malpresentation (frequent in transverse/oblique lie)
Sometimes asymptomatic

Risk Factors

Previous caesarean section (number is critical)
Multiparity
Advanced maternal age (>35)
Smoking
Multiple gestation
Previous placenta previa history
Uterine surgery (myomectomy, dilatation and curettage)
Asherman syndrome

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Vaginal bleeding during pregnancy
  • Pelvic pain or contractions
  • Decreased foetal movements
  • Bleeding episode after diagnosis
  • Approaching planned delivery date
  • Anxiety, breathlessness or syncope

Treatment Methods

01
Detailed transvaginal ultrasound and Doppler
02
MRI evaluation (in cases with suspected accreta)
03
Multidisciplinary team planning
04
Antenatal corticosteroid (24-34 weeks)
05
Planned delivery at 34-36 weeks (caesarean ± hysterectomy)
06
Preoperative blood preparation (massive transfusion protocol)
07
Iliac balloon occlusion (in selected cases)
08
Postoperative intensive care follow-up

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.