. 2023 Apr 1;3(2):100191. doi: 10.1016/j.xagr.2023.100191

Table 3.

Recommendations for undiagnosed placenta accreta spectrum in resource-poor settings

Recommendation to surgeons
1. Always look for a sign of PAS in the anterior wall of the uterus in pregnant women with previous cesarean delivery. 2. If there is a sign of PAS, avoid cutting through the placenta and extract the fetus through a fundal incision. 3. Before such an incision, call for help. Ask the hospital manager for a formal support mechanism in the obstetrical ward or during surgery. 4. Train easy and effective strategies to control pelvic bleeding (as internal manual aortic compression).

Recommendation to surgeons

1.
Always look for a sign of PAS in the anterior wall of the uterus in pregnant women with previous cesarean delivery.
2.
If there is a sign of PAS, avoid cutting through the placenta and extract the fetus through a fundal incision.
3.
Before such an incision, call for help. Ask the hospital manager for a formal support mechanism in the obstetrical ward or during surgery.
4.
Train easy and effective strategies to control pelvic bleeding (as internal manual aortic compression).

Recommendation to hospitals
1. Prepare a plan for massive obstetrical bleeding. 2. Define additional personnel to support the initial response team in the case of undiagnosed PAS during surgery. 3. Define a formal route for emergency transfer of pregnant women with intraoperative PAS finding. 4. Establish a formal telehealth process for severe obstetrical emergencies including PAS.

PAS, placenta accreta spectrum.

Aryananda. Unexpected placenta accreta spectrum in resource-poor settings. Am J Obstet G