The cases of Placenta Accreta Spectrum (PAS) constitute a challenge for Obstetrics. This condition is associated with a high likelihood of obstetric hysterectomy and hemorrhaging, but also with increased morbidity, such as severe multiple-organ failure, ureter, urinary bladder and colon injury, disseminated intravascular coagulation, as well as death of the mother in 7% of the cases.
As a previous C-section carries the highest risk factor for PAS in a subsequent pregnancy, the frequency of PAS cases continues to increase in the last years, following the increase in C-sections.
The increased morbidity and mortality of these cases, as well as the increased frequency of occurrence, render preoperative planning and preparation necessary. The international literature highlights the need to treat PAS cases in dedicated maternity clinics (Centers of Excellence) by a team of specialists in well-organized facilities, which are staffed with suitably trained personnel and have the necessary infrastructure.
Why must Placenta Accreta cases be treated in a Center of Excellence?
Having patients with PAS deliver in Centers of Excellence leads to reduced maternal and neonatal morbidity rates, as well as a lower number of blood transfusion units, compared to non-dedicated maternity clinics. Additionally, mortality due to hemorrhaging in women treated in Centers of Excellence is very low in international literature.
IASO Center of Excellence for Placenta Accreta Spectrum
IASO is equipped with the necessary infrastructure for a Center of Excellence for PAS cases. In particular:
- Adult Intensive Care Unit (ICU)
- Neonatal Intensive Care Unit (NICU)
- Blood Bank
- Cell-Saver Intraoperative Autotransfusion System
- Fetal Medicine Department
- MRI Device
The Coordinator of the dedicated center and the PAS Cases Care Team of IASO Maternity and Gynecology Clinic, Mr. Stavros Fotopoulos, Obstetrician/Gynecologist, has treated a large number of Placenta Accreta cases, not only scheduled, but also emergencies.
The experience of our Center and the results from treating PAS cases
Since March 2016, Mr. Fotopoulos and his team have surgically treated 85 PAS cases. In 40 of these, the placenta grew deeply beyond the uterus and infiltrated the urinary bladder and/or the parametrium (percreta).
Even though in international literature hysterectomy is the norm in extensive infiltration of the placenta beyond the uterus (percreta), in our case, conservative management was performed in 19 out of the 40 cases, and uterine preservation was possible, despite extending to the parametrium and urinary bladder.
Intraoperative Autotransfusion System (Intraoperative Cell Salvage, Cell-Saver)
Another innovation is the introduction of the Cell-Saver Intraoperative Autotransfusion System. The introduction of the Cell-Saver aims at restricting heterologous blood transfusion, meaning blood transfusion from a donor, and, therefore,
any possible impact on the patient.
During intraoperative autotransfusion, the patient’s blood is collected from the surgical field and, after being entered into and processed through the Cell-Saver system, is transfused directly into the patient.
For specific cases, IASO uses the Cell-Saver 5 Plus Intraoperative Autotransfusion System by US HAEMONETICS Corporation.
The system offers a specially designed, low-pressure aspiration tube, which aspirates the blood from the surgical field, without killing the red blood cells. The collected blood passes through a heparin solution, through a white blood cell filter, which traps and removes amniotic fluid cells and possible bacteria or other ingredients, and through saline. Provided the quantity is adequate, the blood is transfused directly into the patient.
What are the benefits and results for the patient from using the Cell-Saver Intraoperative Autotransfusion System?
Autotransfusion is beneficial in many instances compared to heterologous blood transfusion, meaning the transfusion of blood from a donor, as far as the patient is concerned:
- It reduces the infectious and immune complications of heterologous blood transfusions.
- It reduces undesirable events during administration.
- Oxygen delivery to tissue is higher compared to donor blood.
- In cases of massive bleeding in Placenta Accreta, as in a C-section, it is administered immediately as there is no time for blood preparation, which is necessary in heterologous transfusion.
- In the event of difficult blood cross-matching or in cases with rare blood types, such as Rhesus (-) patients.
- In the event that the patient does not wish to receive heterologous blood transfusion, such as Jehovah's witnesses.
Why is the use of the Cell-Saver Intraoperative Autotransfusion System necessary to treat Placenta Accreta cases?
During a C-section in cases of Placenta Accreta, there is massive and rapid blood loss. Immediate transfusion is necessary. In many cases, more than 10 blood units are necessary, which must be transfused rapidly.
Even in scheduled C-sections in these cases, all the required blood quantity may not be available immediately, especially in the event of rare blood types.
The Intraoperative Autotransfusion System offers large quantities of blood immediately and allows surgeons to treat the case in the best possible manner and apply the conservative uterine preservation approach, wherever possible.
Department’s Coordinator – Director
Obstetricians – Gynecologists