No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders
No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders
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DOI：
10.1016/j.jogc.2018.12.004
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发表时间：
2019-07-01
影响因子：
1.8
通讯作者：
Allen, Lisa M.
中科院分区：
文献类型：
--
作者：
Hobson, Sebastian R.;Kingdom, John C.;Allen, Lisa M.
背景资料：胎盘植入谱（PAS）疾病是一种潜在的危及生命的妊娠并发症，需要协调的跨学科护理，以实现更安全的结果。这种疾病的发病率上升是由于越来越多的子宫外科手术，包括剖腹产手术后怀孕的发病率上升。目的：为有效筛查、诊断和管理PAS疾病的最佳方法提供当前循证指南。方法：指南委员会的成员是根据他们在加拿大各地管理这种情况的持续专业知识和实践环境选择的。该委员会审查了英文医学文献中所有可用的证据，包括已发表的指南，并评估了诊断测试，外科手术和临床outcome.Evidence：已发表的文献，包括临床实践指南，通过检索Medline和The科克伦图书馆，使用适当的控制词汇和关键词检索到2018年3月。结果仅限于系统综述、随机对照试验和用英文撰写的观察性研究。这些证据定期更新，并纳入到指南中，直至2018年7月。价值：本文件中的证据质量使用加拿大预防保健工作组报告中描述的标准进行分级。结果：本文件回顾了有关用于疑似PAS疾病女性最佳治疗的可用诊断和手术技术的证据，包括麻醉和跨学科护理的实际考虑。好处，危害，和成本：实施指南的建议，将提高认识这种疾病，并增加受影响的妇女接受跨学科护理的比例在regional centers.Conclusions：跨学科的团队为基础的护理提供准确的诊断服务，协调规划，和更安全的手术提供有效的护理，改善临床结果相比，替代管理。
Background: Placenta accreta spectrum (PAS) disorders are a potentially life-threatening complication of pregnancy that demand coordinated interdisciplinary care to achieve safer outcomes. The rising incidence of this disease is due to a growing number of uterine surgical procedures, including the rising incidence of pregnancy following Caesarean section.Objective: To provide current evidence-based guidelines on the optimal methods used to effectively screen, diagnose, and manage PAS disorders.Methods: Members of the guideline committee were selected on the basis of their ongoing expertise in managing this condition across Canada and by practice setting. The committee reviewed all available evidence in the English medical literature, including published guidelines, and evaluated diagnostic tests, surgical procedures, and clinical outcomes.Evidence: Published literature, including clinical practice guidelines, was retrieved through searches of Medline and The Cochrane Library to March 2018 using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized controlled trials, and observational studies written in English. Searches were updated on a regular basis and incorporated in the guideline to July 2018.Values: The quality of evidence in this document was graded using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.Results: This document reviews the evidence regarding the available diagnostic and surgical techniques used for optimal management of women with suspected PAS disorders, including anaesthesia and practical considerations for interdisciplinary care. Benefits, Harms, and Costs: Implementation of the guideline recommendations will improve awareness of this disease and increase the proportion of affected women receiving interdisciplinary care in regional centres.Conclusions: Interdisciplinary team-based care providing accurate diagnostic services, coordinated planning, and safer surgery deliver effective care with improved clinical outcomes in comparison with alternative management.