Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta

Sally L Collins; Bahrin Alemdar; Heleen J van Beekhuizen; Charline Bertholdt; Thorsten Braun; Pavel Calda; Pierre Delorme; Johannes J Duvekot; Lene Gronbeck; Gilles Kayem; Jens Langhoff-Roos; Louis Marcellin; Pasquale Martinelli; Olivier Morel; Mina Mhallem; Maddalena Morlando; Lone N Noergaard; Andreas Nonnenmacher; Petra Pateisky; Philippe Petit; Marcus J Rijken; Mariola Ropacka-Lesiak; Dietmar Schlembach; Loïc Sentilhes; Vedran Stefanovic; Gita Strindfors; Boris Tutschek; Siri Vangen; Alexander Weichert; Katharina Weizsäcker; Frederic Chantraine; International Society for Abnormally Invasive Placenta (IS-AIP)

doi:10.1016/j.ajog.2019.02.054

Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta

Am J Obstet Gynecol. 2019 Jun;220(6):511-526. doi: 10.1016/j.ajog.2019.02.054. Epub 2019 Mar 5.

Authors

Sally L Collins¹, Bahrin Alemdar², Heleen J van Beekhuizen³, Charline Bertholdt⁴, Thorsten Braun⁵, Pavel Calda⁶, Pierre Delorme⁷, Johannes J Duvekot⁸, Lene Gronbeck⁹, Gilles Kayem¹⁰, Jens Langhoff-Roos⁹, Louis Marcellin¹¹, Pasquale Martinelli¹², Olivier Morel⁴, Mina Mhallem¹³, Maddalena Morlando¹⁴, Lone N Noergaard⁹, Andreas Nonnenmacher⁵, Petra Pateisky¹⁵, Philippe Petit¹⁶, Marcus J Rijken¹⁷, Mariola Ropacka-Lesiak¹⁸, Dietmar Schlembach¹⁹, Loïc Sentilhes²⁰, Vedran Stefanovic²¹, Gita Strindfors², Boris Tutschek²², Siri Vangen²³, Alexander Weichert⁵, Katharina Weizsäcker⁵, Frederic Chantraine¹⁶; International Society for Abnormally Invasive Placenta (IS-AIP)

Affiliations

¹ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK. Electronic address: sally.collins@wrh.ox.ac.uk.
² Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden.
³ Department of Gynaecological Oncology, Erasmus Medical Center, Rotterdam, Netherlands.
⁴ Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, France.
⁵ Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
⁶ Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic.
⁷ Port-Royal Maternity Unit, Cochin Hospital, Paris-Descartes University, DHU Risk and Pregnancy, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
⁹ Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark.
¹⁰ Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France.
¹¹ Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, APHP; Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, Paris, France.
¹² Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.
¹³ Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹⁴ Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy; Department of Women, Children and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy.
¹⁵ Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Obstetrics and Gynecology, CHR Citadelle, University of Liege, Liege, Belgium.
¹⁷ Vrouw & Baby, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.
¹⁸ Department of Perinatology and Gynecology, University of Medical Sciences, Poznan, Poland.
¹⁹ Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany.
²⁰ Department of Obstetrics and Gynecology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.
²¹ Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Finland.
²² Prenatal Zurich, Zürich, Switzerland; Heinrich Heine University, Düsseldorf, Germany.
²³ Division of Obstetrics and Gynaecology, Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

PMID: 30849356
DOI: 10.1016/j.ajog.2019.02.054

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 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.

Keywords: abnormally invasive placenta; accreta; guideline; increta; morbidly adherent placenta; percreta; placenta; placenta accreta spectrum.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Cesarean Section*
Conservative Treatment
Delphi Technique
Disease Management
Female
Gestational Age
Hospitalization
Humans
Hysterectomy*
Oxytocics / therapeutic use
Oxytocin / therapeutic use
Patient Positioning
Placenta Accreta / therapy*
Postpartum Hemorrhage / prevention & control*
Postpartum Hemorrhage / therapy
Pregnancy
Stents
Ureter
Watchful Waiting

Substances

Adrenal Cortex Hormones
Oxytocics
Oxytocin