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 PetitMarcus 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)


    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.

    TidsskriftAmerican Journal of Obstetrics and Gynecology
    Udgave nummer6
    Sider (fra-til)511-526
    Antal sider16
    StatusUdgivet - jun. 2019


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