Placenta accreta spectrum: A 10-year urogynecologist perspective in a tertiary referral center in the Philippines – A retrospective cohort study
Myza C. Espallardo, Almira J. Amin-Ong, Ira Dominique T. Alatraca-MalonzoAbstract:
INTRODUCTION:
With increasing cesarean delivery rates, placenta accreta spectrum (PAS) disorders have become more common, causing significant morbidity and mortality.
MATERIALS AND METHODS:
These cases often require referral to surgeons with urologic expertise, especially when bladder involvement is suspected. We examined the diagnostic patterns of PAS disorders, compared clinical outcomes, and identified prognostic factors associated with these outcomes. This was a retrospective study including 54 patients identified to have PAS from 2015 to 2024. Urologic, maternal, and neonatal outcomes were defined. Statistical analyses were made using appropriate parametric and nonparametric tests and regression analysis.
RESULTS:
Forty-two cases (78%) were histologically confirmed: 15 accreta, 23 increta, and 4 percreta, including 3 with bladder invasion (2 serosa, 1 full-thickness). Antenatal imaging identified 36 (86%) of confirmed cases. Preoperative cystourethroscopy was done for nonemergent cases and showed patterns correlating with intraoperative and histopathologic findings. Nine patients sustained iatrogenic cystotomies, one underwent ureterolysis, and one required partial cystectomy. Emergency referrals were significantly associated with adverse urologic outcomes (odds ratio: 25.4,
CONCLUSION:
Although findings must be interpreted with caution due to limited statistical power arising from the modest sample size, this study demonstrated that early PAS detection and referral to a multidisciplinary team are key contributors to clinical outcomes. A multidisciplinary management algorithm may enable clinicians to plan a safe delivery and prevent serious complications for PAS patients.