Placenta accreta spectrum: intraoperatory analysis for immediate tele-help

Placenta accreta spectrum (PAS) is a potentially fatal disease. A quarter of PAS cases are not detected during prenatal evaluations, so obstetricians without experience with this disease may encounter complex cases without having the necessary resources. We report a series of PAS intraoperative finding (IOF) cases and analyze useful strategies to improve patient outcomes. Four cases of PAS IOF are reported. These patients were women with previous pregnancies terminated by cesarean section, with placenta previa/anterior, and whose prenatal ultrasound did not detect PAS. Three patients were candidates for the postponement of cesarean section and/or hysterectomy. One case had active vaginal bleeding, so it was not feasible to delay surgery. Patients who benefited from delaying surgery or seeking additional help through telesupport had better clinical outcomes. Decisions about which interventions to conduct and which to delay in cases of PAS intraoperative finding can determine the clinical outcome.胎盘植入性疾病（Placenta accreta spectrum, PAS）是一种潜在致命性疾病。约四分之一的PAS病例在产前评估中未被检出，因此缺乏该疾病诊疗经验的产科医师可能会在无必要资源支持的情况下遭遇复杂病例。本文报告了一组PAS术中所见（Intraoperative Finding, IOF）病例，并分析了可改善患者临床预后的有效策略。本次共报告4例PAS术中所见病例，患者均有既往剖宫产终止妊娠史，合并前置胎盘/前位胎盘，且产前超声未检出PAS。其中3例患者可择期行剖宫产术及/或子宫切除术，1例因出现活动性阴道出血而无法延迟手术。通过延迟手术或借助远程支持寻求额外协助的患者，临床结局更佳。针对PAS术中所见病例，干预措施的选择与手术时机的把控可直接影响临床结局。