Management and Outcomes of Placenta Accreta Spectrum (PAS) at Tertiary Hospital in Bali: Descriptive Case Series Study

Abstract

Objectives: To describe the management and outcomes of placenta accreta, increta, and percreta at a tertiary hospital in Bali, Indonesia.

Background: There are three variants of abnormal placentation: placenta accreta, placenta increta, and placenta percreta. The lack of data and review studies on Placenta Accreta Spectrum (PAS) in Indonesia, including Bali, makes it difficult for clinicians to diagnose and predict potential morbidity.

Methods: A prospective case series of 41 pregnancies with placenta accreta identified between 2018 and 2020 at Sanglah Hospital, a tertiary hospital in Bali, Indonesia.

Results: Among the cases, 1 was a primigravida with placenta accreta (2.6%), 4 cases (10.5%) had PAS without a history of prior cesarean section, and 20 cases (52.6%) had PAS without a history of curettage. Thirty-two cases (84.2%) had anterior placental implantation, while 6 cases (15.8%) had posterior placental implantation. The median Placenta Accreta Index (PAI) score was 6 (range: 1.25-10). All cases were managed with elective cesarean hysterectomy, with the median blood loss being 2,000 mL (range: 400–13,300 mL). Bladder rupture occurred as a complication in 11 cases (28.9%), and relaparotomy was performed in 3 cases (7.9%). Twelve cases (31.6%) required postoperative blood transfusion, and 28 cases (73.7%) required intensive postoperative care in the ICU/HCU.

Conclusions: Antenatal history-taking and ultrasound examination are essential for predicting Placenta Accreta Spectrum (PAS). Once PAS is diagnosed, a multidisciplinary approach should be implemented to reduce maternal and perinatal morbidity and mortality.