Review Article
Volume 3 Issue 5 - 2020
Reducing Maternal Morbidities in Placenta Accreta Spectrum Disorders (PASD)
Hermanto TJ*
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Dr Soetomo General Hospital, Reproductive Health Magister Program, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
*Corresponding Author: Hermanto TJ, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Dr Soetomo General Hospital, Reproductive Health Magister Program, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
Received: February 18, 2020; Published: April 09, 2020




Abstract

Placenta Accrete Spectrum Disorder refers to morbidly adherence placenta which cause so many morbidities and even mortalities in Indonesia and worldwide. Dr Soetomo General Hospital has managed hundred PASD cases by interdisciplinary team approach with steeper and steeper learning curve. In order to reduce morbidities and mortalities we analyze our cases and worldwide cases and share in this paper.

Our data and also from other writers b. diagnosis should be accurate diagnosis c. developing world should be developing countries stated that there are some the efforts that can be done 1. Before pregnancy: history of previous cesarean delivery even only one is early warning, incomplete niche development in cesarean scar, appropriate interpregnancy interval, assessment of surgical technique 2. First trimester: screening for cesarean scar pregnancy or cross over sign assessment 3. Second to third trimester: screening by placenta accrete index play important role, placental mapping at tertiary center is mandatory including cervical length measurement, admission to the hospital in some cases, blood preparation, timely referral system, interdisciplinary team approach especially with vascular surgeon, delivery at 34 - 35 weeks in semi-elective approach, diagnosis(placenta mapping). It also seems that preventing primary cesarean delivery especially for breech and maternal request, VBAC - TOLAC in appropriate cases gave the best outcomes.

For developing world such as Indonesia, prevention is much better than the cure. Prevention of primary cesarean delivery, VBAC, timely screen, refer, diagnosis and manage in team approach seem give best results.

Keywords: PASD; Morbidities Prevention; Primary CD; VBAC; Appropriate Screen; Diagnosis and Birth Management

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Citation: Hermanto TJ. “Reducing Maternal Morbidities in Placenta Accreta Spectrum Disorders (PASD)”. EC Clinical and Medical Case Reports 3.5 (2020): 19-26.

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