Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When counseling patients about potential complications associated with placenta accreta spectrum (PAS) during antenatal visits, it is important to discuss several key aspects of diagnosis, management, and birth options NICE NG192.
- Diagnosis and Referral: If a routine 20-week ultrasound scan shows placenta praevia or a low-lying placenta in a patient with a previous caesarean or uterine scar, they will be referred for a greyscale ultrasound scan with colour Doppler to assess for PAS NICE NG192. This specialized scan should be performed around 28 weeks, but no later than 29 weeks, by a senior clinician with expertise in PAS diagnosis NICE NG192. If PAS is suspected, the patient will be referred to a specialist placenta accreta spectrum centre for ongoing care and management NICE NG192.
- Further Assessment: An MRI scan may be considered to complement ultrasound findings when planning surgical management of PAS NICE NG192. Patients should be informed about what to expect during an MRI procedure and that it can help clarify the degree of invasion, especially with a posterior placenta NICE NG192. It should also be discussed that current experience suggests MRI is safe, but there is a lack of evidence about any long-term risks to the baby NICE NG192.
- Birth Options and Potential Complications: A senior obstetrician will discuss birth options with the patient, including the timing of birth and operative interventions NICE NG192. This discussion will cover the possibility of a hysterectomy and the potential need for blood transfusion NICE NG192. Patients should be aware that placental adherence problems, particularly after multiple caesarean births, are a relevant risk NICE NG192. For planned caesarean birth in suspected PAS, a multidisciplinary team will be involved, including specialists such as gynaecological surgeons, interventional radiologists, colorectal surgeons, urologists, or vascular surgeons, depending on the nature of the PAS NICE NG192. During a planned caesarean birth for a woman or pregnant person suspected to have PAS, a consultant obstetrician, a consultant gynaecologist, and a consultant anaesthetist will be present in the operating theatre NICE NG192. A paediatric or neonatal registrar or consultant will also be present to provide immediate care for the baby NICE NG192. A haematology registrar or consultant should be available for advice, and a critical care bed for the patient and a neonatal cot for the baby should be available NICE NG192. Sufficient cross-matched blood and blood products will be readily available if blood transfusions are acceptable to the patient NICE NG192.