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The following is a summary of “Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care,” published in the August 2024 issue of Obstetrics and Gynecology by Premkumar et al.
Given the limitations inherent in perioperative management at freestanding abortion clinics, providers frequently face the challenge of determining which patients require referral to hospital-based abortion care due to the complexity of their cases. The transition from a freestanding clinic to a hospital setting can result in delays in abortion procedures, leading to substantial social, economic, and psychological consequences for patients. A particularly complex clinical scenario is the suspicion of placenta accreta spectrum (PAS), a severe condition that significantly contributes to maternal morbidity and mortality in the United States.
PAS necessitates specialized, multidisciplinary management to optimize patient safety and outcomes. This Clinical Opinion article reviews current literature on identifying patients at risk for PAS beyond 14 weeks of gestation. It presents an algorithm to enhance the timeliness of referrals to hospital-based providers. The proposed algorithm seeks to streamline the referral process, reducing delays and improving patient care. Additionally, researchers advocate for future advancements in training and research to better address PAS in the second trimester, emphasizing the need for greater collaboration between complex family planning specialists and maternal-fetal medicine experts.
This approach aims to refine the management strategies for PAS and improve overall outcomes for patients undergoing abortion procedures in the presence of this challenging condition.
Source: sciencedirect.com/science/article/abs/pii/S0002937824008202
