Interval Placental Delivery: A New Approach to Deal with Placenta Accreta Spectrum (PAS) Disorders: A Cohort Study

Background: Placenta accreta spectrum (PAS) disorders are one of the most terrible conditions in obstetrics.The major complication associated with PAS disorders is massive hemorrhage, which ultimately may lead to maternal death.Objectives: This study aimed to detect the optimum time and mode of interventions to remove the morbidly adherent placenta after leaving it in situ for conservative management.Patients and Methods: This was a cohort study carried out at the Obstetrics and Gynecology Department, Minia Maternity and Children University Hospital through the period from March 2018 to December 2020.The total number of patients with a placenta that was left in place was 20 patients out of 29 patients who were eligible for the study.Results: This approach of leaving the placenta in place then interval placental delivery was successful in 16 cases (80%).Four cases needed hysterectomy.Placental removal was through spontaneous placental resorption in one case (5%), a spontaneous expulsion of the placenta in one case (5%), in addition to a successful interval placental delivery through D & C in 2 cases (10%) as well as removal by mini-laparotomy in 12 cases (60%).The mean time between the cesarean section and the 2 nd set of interventions to remove the placenta was 48.2 ± 6.7 days. Conclusion:Conservative treatment by leaving the placenta in place followed by interval placental delivery seemed to be an appropriate management choice in selected patients desiring preservation of the uterus, but complications such as sepsis and secondary postpartum hemorrhage should be carefully diagnosed and appropriately managed.