Observation of Strategies in Placenta Accreta Spectrum Management

Evolving Strategies in Placenta Accreta Spectrum Management: A Ten-Year Institutional Review

• Placenta accreta spectrum (PAS) disorders represent a significant obstetric challenge, characterized by abnormal adherence of the placenta to the uterine wall, leading to potentially life-threatening hemorrhage (ACOG 2020; RCOG 2018; Jauniaux 2019) during delivery. PAS includes placenta accreta (attachment to the myometrium), increta (invasion into the myometrium), and percreta (penetration through the uterine serosa, often involving adjacent organs). The incidence of PAS is rising globally, largely attributed to the increased rates of cesarean section and uterine surgeries (Bowman 2021).

Effective management of PAS is crucial to prevent severe maternal morbidity and mortality. The cornerstone of management remains surgical intervention, with cesarean hysterectomy being the traditional gold standard (Eller 2009; ACOG 2020), especially in cases of extensive invasion. However, conservative and fertility-preserving surgical techniques have emerged in recent years as viable alternatives in selected cases (Jauniaux 2019).

In Assiut university hospital, diverse surgical approaches are practiced depending on the extent of placental invasion, surgeons expertise, and patient fertility desires. These include cesarean hysterectomy, segmental uterine resection, the Triple-P procedure, and uterus-preserving methods such as leaving the placenta in situ. (ijrcog) A notable contribution to conservative PAS management in Egypt is the Placental Pouch Closure technique. This technique involves careful resection of the invaded uterine wall followed by multilayered closure of the resulting myometrial defect (the "placental pouch"), thereby controlling hemorrhage while preserving uterine integrity.

(Zahran et al. 2020) .

• This retrospective study aims to evaluate the pattern and outcomes of various surgical approaches used in the management of placenta accreta spectrum disorders over a 10-year period at a Assiut university hospital. Special attention will be paid to the adoption, safety, and effectiveness of conservative techniques

Inclusion Criteria:

• - Women diagnosed with PAS (accreta, increta, percreta).
• Deliveries conducted at Women's Health Hospital.
• Age 18-50 years.
• Availability of complete medical records and operative details.

Exclusion Criteria:

• - Patients with incomplete records or missing surgical reports.
• Cases managed outside the hospital.