Appointments: 972-566-8585
Placenta accreta spectrum (PAS) refers to a range of placental disorders all of which describe an abnormally attached placenta to the uterine wall during pregnancy. Placenta accreta spectrum includes three distinct subtypes of increasing placental invasion; placenta accreta, placenta increta and placenta percreta. PAS poses a dramatic risk for massive bleeding which can rapidly result in blood loss approaching 40-50% of the maternal blood volume. Placenta accreta spectrum leads to maternal death rates approaching 6-7% primarily due to massive bleeding, but significant maternal harm may also occur such as multiorgan failure, acute respiratory failure, renal failure and blood clotting abnormalities.
The incidence of placenta accreta spectrum is rising. The increasing frequency of placenta accreta spectrum over the last twenty years is most probably due to the increased rate of cesarean deliveries. According to a 2016 study, the overall incidence of placenta accreta in the United States was 1 in 272 deliveries, up from previous findings of 1 in 500 deliveries.
Studies have demonstrated that women with PAS have improved outcomes if the delivery is performed in a center of excellence by a multidisciplinary team with experience and expertise in the management of placenta accreta. The three criteria that define a PAS Center of Excellence are 1) Multidisciplinary coordinated team approach to delivery of the patient with PAS, 2) supporting capabilities to include a 24 hours a day/7 days a week intensive care unit, interventional radiology with access to both a specialized hybrid operating room and a Neonatal intensive care unit and 3) a 24 hours a day/7 days a week blood transfusion capability that can support a massive transfusion of blood products to the mother, experienced resuscitation physicians, cell saver ability and familiarity with alternative blood products.
According to the Obstetric Care Consensus on Placenta Accreta Spectrum No. 7, 2018, which was developed jointly by the American College of Obstetricians and Gynecologist and the Society for Maternal-Fetal Medicine, “Optimum management (of PAS) involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and a strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place.” (italics added).
Despite the increasing incidence of PAS, most facilities and obstetricians who deliver these patients have personally managed only a small number of women with this condition. It is imperative that patients with PAS educate themselves not only on the condition, but also to find the most experienced and safest place for delivery and post-delivery care for themselves and their baby.
Placenta Accreta Specialists is a multidisciplinary team of specialists who have each practiced for two to three decades in their respective fields. Our team is composed of Obstetricians with extensive experience managing PAS, Maternal Fetal Medicine specialists with familiarity in high risk pregnancies, Anesthesiologists with extensive experience in resuscitation from blood loss, Urologists with PAS expertise, Interventional Radiologists with expertise with the placement of the newest catheters to mitigate blood loss in high risk patients, Pathologist with proficiency in blood bank medicine and General and Vascular surgeons. Though many medical authors who have written on the importance of having a multidisciplinary team approach to the care of the patient with PAS, what has not been equally stressed is that this multidisciplinary team must have extensive experience working together and equally important must be immediately available during PAS surgery.
Placenta Accreta Specialists is a multidisciplinary coordinated team of specialists composed of a core group of physicians who have decades of experience and expertise working together, not only on patients with PAS, but with routine patients as well. Our team has honed its approach to PAS patients incorporating the newest technologies and capabilities. Our team was the first in North Texas to routinely utilize the REBOA catheter, a device which is placed before delivery and allows the control of blood loss after the fetus is delivered. Placement of the REBOA catheter has become routine in our PAS and has allowed surgery to proceed in a safer and more expeditious manner in our opinion. Our transfusion capabilities are cutting edge incorporating not only blood products, but non-blood products that assist in minimizing the need for blood product transfusion.
If you have been diagnosed with PAS, take a moment to call us. We would be happy to start a conversation of how you can make the best decision on where to delivery you baby.
Dr. Cohen and his team absolutely saved my life. I had an MRI when I was approximately 30 weeks pregnant and it was diagnosed that I had Placenta Increta. After given the news that I was going to deliver my daughter at 33 weeks of pregnancy due to the severity of my placenta increta, I knew I was in more than capable hands. The Placenta Accreta team knew their exact game plan for my delivery, and I never had a doubt in my mind that they knew what they were doing. They eased mine and my husband’s minds and answered many, many questions for us, as well as giving us a play-by-play for how delivery and surgery would go. I know their team saved mine and my daughter’s lives, and will be forever grateful to them.
Brittany
I know without a doubt that if it wasn’t for Dr Cohen and his fantastic team that my son and I wouldn’t be alive today. I was admitted at 27weeks and at 34 weeks Dr Cohen and his huge team of drs, nurses, and many other people used the REBOA to save mine and my son’s life. The 62 days I spent there I never had a doubt that that was EXACTLY where I needed to be. They answered any and every question I had and never were in a rush to get on about their day. I can’t begin to thank them for everything that they did for me and my family. Thanks,
Emily
To schedule an appointment, please send us a message or give us a call during our business hours.
7777 Forest Ln, Suite C-336 , Dallas, Texas 75230,
Monday - Friday: 8am - 5pm
Saturday - Sunday: Closed
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