Urological Involvement in the Multidisciplinary Management of Placenta Accreta Spectrum in a Centralised, High-Volume Centre: A Retrospective Analysis
Abstract
Objectives: Placenta accreta spectrum (PAS) significantly increases the complexity of childbirth and frequently
involves urologic organs. Multidisciplinary team (MDT) care is paramount to ensure optimal outcomes. We aimed to
evaluate urologic interventions in patients with PAS at a centralised, tertiary referral centre.
Methods: An analysis of a prospectively collected data set, consisting of all women presenting with PAS at our
institution between November 2013 and June 2019. Patients who required urological intervention were identified, and
perioperative details were retrieved.
Results: Forty-two cases of PAS were identified. The mean maternal age was 35 years, and mean gestational age
at delivery was 34 weeks. Thirty-seven cases were managed electively, with 5 cases managed conservatively (no
hysterectomy) and 5 requiring emergency management. Fifteen patients (36%) had suspected bladder invasion on
MRI. A total of 36 patients (86%) had ureteric catheters inserted, 14 (33%) required bladder repair, and 2 had ureteric
injuries (5%).
Conclusions: PAS frequently requires urological intervention to prevent and repair injury to the urinary bladder
and ureter. PAS is a rare condition that is best managed in an MDT setting in a centralised, tertiary, high-volume
centre with access to a variety of medical and surgical sub-specialities.
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