Evidence-based guidelines for the management of abnormally invasive placenta recommendations from the International Society for Abnormally Invasive Placenta
International Society for Abnormally Invasive Placenta (IS-AIP)
(2019) American Journal of Obstetrics and Gynecology, volume 220, issue 6, pp. 511 - 526
(Article)
Abstract
The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society
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for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.
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Keywords: abnormally invasive placenta, accreta, guideline, increta, morbidly adherent placenta, percreta, placenta, placenta accreta spectrum, Patient Positioning, Adrenal Cortex Hormones/therapeutic use, Humans, Postpartum Hemorrhage/prevention & control, Oxytocics/therapeutic use, Delphi Technique, Placenta Accreta/therapy, Female, Ureter, Stents, Conservative Treatment, Hospitalization, Hysterectomy, Gestational Age, Pregnancy, Cesarean Section, Oxytocin/therapeutic use, Watchful Waiting, Disease Management, Obstetrics and Gynaecology, Journal Article, Research Support, Non-U.S. Gov't, Practice Guideline
ISSN: 0002-9378
Publisher: Mosby Inc.
Note: Funding Information: We would like to thank the past and present membership of the IS-AIP, formerly the European Working group on AIP (EW-AIP), for their dedication to this international collaboration aimed at improving the outcomes for women affected by AIP worldwide. We would like to thank all of the librarians who assisted with more than 30 searches, especially Ms. Nia Roberts, Librarian at University of Oxford. Pavel Calda is supported by a research grant (RVO-VFN64165) from the Ministry of Health of the Czech Republic. Funding Information: We would like to thank the past and present membership of the IS-AIP, formerly the European Working group on AIP (EW-AIP), for their dedication to this international collaboration aimed at improving the outcomes for women affected by AIP worldwide. We would like to thank all of the librarians who assisted with more than 30 searches, especially Ms. Nia Roberts, Librarian at University of Oxford. Pavel Calda is supported by a research grant (RVO-VFN64165) from the Ministry of Health of the Czech Republic. Publisher Copyright: © 2019 Elsevier Inc.
(Peer reviewed)