Dear Colleagues,
Placenta accreta spectrum (PAS) is a complex obstetric condition characterized by abnormal trophoblast invasion into the uterine wall during placentation. A clinical-based PAS disorders classification recognizes an “abnormally adherent placenta” which does not separate from the uterus with conservative manual approach; an “abnormally invasive placenta (increta)” which shows macroscopic hypervascularity features and when gentle cord traction is made, uterus retraction without placental detachment follows (dimple sign) and an “abnormal invasive placenta (percreta)” with macroscopic uterine serosa invasion (IIIA), bladder invasion (IIIB) or even invasion of distant pelvic structures (IIIC) [8, 9].
Antenatal diagnosis of placenta percreta is essential for planning its management in order to reduce maternal morbidity and mortality. There are no well-controlled observational studies, and therefore, no firm recommendations can be made. Further evidence from the literature shows that the most common treatment for placenta percreta is a scheduled caesarean delivery followed by hysterectomy, managed by a multidisciplinary team.
In the Royal College guidelines [12] four surgical approaches are viable: • Primary hysterectomy following delivery of the fetus. • Delivery of the fetus avoiding the placenta, and repair of the incision leaving the placenta in situ. • Delivery of the fetus without disturbing the placenta, followed by partial excision of the uterine wall (placental implantation site) and repair of the uterus. • Delivery of the fetus without disturbing the placenta, leaving it in situ, followed by elective secondary hysterectomy at day 3-7.
This Special Issue titled “Management of Bladder Invasion of Placenta Percreta” will cover areas including Diagnosis, Surgical and Medical management, ideal timing of delivery for these patients, and a review of placental, observational and retrospective studies. Original studies and reports will be accepted for review.
We invite original work and reviews that report developments in improving the diagnosis, treatment, and prognosis of the management of bladder invasion of placenta percreta.
Dr. Gianluca Raffaello Damiani
Guest Editor
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