OP68 Placenta accreta spectrum (PAS): data review of PAS cases successfully managed by a trained multidisciplinary team in our tertiary referral hospital

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Background and Aims Placenta accreta spectrum (PAS), is frequently associated with severe obstetric haemorrhage, anaesthesia risks and high mortality. We present a data review of PAS cases successfully managed by a trained, comprehensive, multidisciplinary team in an Italian Tertiary referral hospital. Methods The analysis includes all PAS cases which have been managed between 2020 and 1st semester of 2024 at Casa Sollievo della Sofferenza (CSS), city of San Giovanni Rotondo, Italy Results During the study period, 19 women underwent Caesarean Section for PAS-related reasons. More than half women were preterm at time of delivery and almost 100% had almost one previous caesarean section (CS) in their obstetric history. Regarding Obstetric management during pregnancy, 66.7% were placenta praevia major cases. MRI was performed in 3 cases. Regarding Multidisciplinary management at time of delivery, almost half CS were performed in Hybrid Operating Room; more than half were conducted under Regional Anaesthesia and for all of them interventional radiologic procedures with preoperative placement of catheters were carried out; iliac arteries occlusion was necessary for half of them. Ureteral stents were placed in 2 cases. Peripartum Hysterectomy was performed in 4 cases and one third of them were admitted to the ICU. More than half newborns were admitted to the NICU. No maternal or neonatal deaths occurred. Conclusions CSS has developed an internal protocol for managing PAS cases. We presented our cases successfully managed by a trained, comprehensive, multidisciplinary team, composed of Gynaecologists, Obstetricians, Sonographers, Anaesthesiologists, Urologists and Interventional Radiologists. A careful antepartum diagnosis by ultrasound imaging is critical to get ready for surgery; surgical and anaesthetic skills are significant to reduce risk of injury; interventional radiologic technique is fundamental to minimise high risk of intraoperative haemorrhage. These skilled facilities are fundamental for optimal management of these increasingly frequent cases.

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