2024 年 38 巻 3 号 p. 156-165
Placenta accrete spectrum disorders (PAS) is a life-threatening obstetrical condition. Prenatal diagnosis of PAS is crucial in planning its management and has been shown to reduce maternal morbidity and mortality. Major guidelines for PAS recommend that patients diagnosed with PAS should be cared for in a specialist center by a multidisciplinary team with expertise. On the other hand, it is well known that placenta previa and previous cesarean deliveries are significant risk factors for PAS. From 2011, we have predicted PAS in pregnant women with placenta previa by using our original scoring system. In addition, in our hospital, patients with placenta previa suspected to have PAS receive preoperative internal iliac artery balloon occlusion catheter placement. We have improved our strategies for management of PAS in patients with placenta previa, and have performed uterine artery embolization followed by cesarean hysterectomy since 2015. Although guidelines do not recommend routine use of interventional radiology (IVR) techniques, we believe that surgical strategies combined with IVR are effective for reducing intraoperative blood loss in patients with PAS and placenta previa.
