National reference center for the diagnosis and management of placenta accreta spectrum (PAS). Five years of experience

Mariana Juárez, Maternal Fetal Medicine Service, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
Fausto M. Coronel, Maternal Fetal Medicine Service, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
José J. Ortiz, Maternal Fetal Medicine Service, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
José A. Carranco, Maternal Fetal Medicine Service, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
Lino E. Cardiel, Gynecology and Obstetrics Service, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico

Introduction: Placenta accreta spectrum (PAS) is a serious obstetric complication where the placenta abnormally adheres to the uterus, posing risks of severe hemorrhage and maternal and neonatal mortality. Since 2018, has implemented multidisciplinary protocols to improve outcomes, promoting appropriate surgical management in a specialized center. Objective: To evaluate the effectiveness of the diagnostic and management algorithms for PAS implemented at the Hospital General de México Dr. Eduardo Liceaga over 5 years. Material and methods: This observational, cross?sectional, and descriptive study was conducted at the Hospital General de México Dr. Eduardo Liceaga and included 100 patients between. Various factors were evaluated, including age, parity, history of previous uterine surgeries, placenta previa, early ultrasonographic diagnosis, type of accreta, surgical management (cesarean, hysterectomy, and arterial embolization), maternal and neonatal complications, transfusions, and histopathological data. Results: In our studied population, with an average age of 32.38 ± 6.1 years and an 3 ± 1.0 pregnancies, a high association was found between placental accreta and factors such as previous cesareans (average 1.46), placenta previa (62%), and type of accreta (31% acreta, 33% increta, and 35% percreta). Total hysterectomy was the predominant treatment (89%) with few complications, highlighting vesical injuries in 10%. A low maternal mortality rate and a high preterm birth rate in neonates (average gestational age 35.3 weeks and average weight 2567.3 g) were reported. Conclusion: This study demonstrates that the implementation of a specialized diagnostic and multidisciplinary surgical management protocol at the Hospital General de México has significantly improved outcomes for patients with PAS. Early identification through ultrasonography and color Doppler, along with surgical techniques such as uterine artery embolization and the placement of double J catheters, contributed to low maternal mortality and effective management of complications.

Keywords: Placenta accreta spectrum. Embolization. Uterine arteries. Hysterectomy. Hemorrhage.