North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Arlington
Specialty
Obstetrics & Gynecology
Document Type
Poster
Publication Date
2025
Keywords
placenta accreta spectrum disorder, PASD, placenta percreta, surgical protocol
Disciplines
Female Urogenital Diseases and Pregnancy Complications | Medicine and Health Sciences | Obstetrics and Gynecology
Abstract
Introduction Placenta Accreta Spectrum Disorder (PASD) refers to a spectrum of abnormal invasion of the placenta into the uterus during pregnancy. PASD ranges in severity from involvement through the endometrial layer of the uterus to complete invasion involving other pelvic structures. This abnormal invasion can result in significant postpartum hemorrhage, often requiring large-volume transfusions, about six units of packed red blood cells on average. The maternal mortality rate associated with PASD is approximately 4-7%. The Society for Maternal-Fetal Medicine (SMFM) recommends that pregnancies complicated by PASD be delivered in hospitals with dedicated interdisciplinary teams, referred to as “Accreta Centers of Excellence.” The management of PASD requires readily accessible blood products with the capability to activate massive transfusion protocols (MTP). Methods This outline details the standardized protocol for performing cesarean hysterectomies for PASD, utilized at a large community hospital with an established interdisciplinary team dedicated to reducing morbidity and mortality. The team is comprised of obstetricians with expertise in PASD, maternal-fetal medicine specialists, anesthesiologists, interventional radiologists, urologists, and critical care physicians. The protocol consists of preoperative considerations, necessary equipment, day-of-surgery planning, surgical setup, the use of intravascular balloons, surgical techniques, and postoperative considerations. Additionally, it includes digital media to further illustrate the required equipment and surgical approach. Conclusion Established through the experience of managing over 200 PASD cases spanning over twelve years, this protocol serves as a comprehensive guide for performing cesarean hysterectomy in PASD. It is intended to be shared with other institutions to promote knowledge sharing and foster collaboration to potentially improve surgical outcomes and the standardization of care.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Adams, Ana; Rodriguez, Monica; Hansen, Kate; Erdemir, Aysu; and Cohen, Robert, "A Standardized Surgical Protocol for Placenta Accreta Spectrum Disorder at an Accreta Center of Excellence" (2025). North Texas Research Forum 2025. 88.
https://scholarlycommons.hcahealthcare.com/northtexas2025/88
Included in
Female Urogenital Diseases and Pregnancy Complications Commons, Obstetrics and Gynecology Commons