Overview

 

Problem to solve?

Abnormally invasive placenta (AIP) defines abnormally invasive placental implantation, which are at high risk of inducing severe obstetrical complications, such life-threatening hemorrhage during delivery. This condition affects 1/533-1/2510 deliveries1-4 and its incidence is associated with the increase of uterine surgery, mainly the cesarean section and has increased 10-fold over the past 50 years5.

European Problem?

The same increase in cesarean section rates and in AIP cases is observed in European countries. Therefore the recognition of this rare condition by the healthcare providers and the support of EU are mandatory to develop an efficient management policy reducing effectively the maternal and neonatal morbidity and mortality.

Solution available?

Improvement of prenatal diagnosis of AIP and referral of the patient to a expertise center in order to organize the delivery in the best conditions are mandatory to improve the outcome6, 7. That policy is far to be applied routinely for this moment in Europe.

Diseases registries play an important part in improving health outcomes8. They also reduce the costs of health care. Through the use of such registries, health-care providers can compare, identify and adopt best practices for patients. Since in most countries, governments support registries of rare diseases financially, we believe that it is time to develop an AIP registry in order to improve obstetrical healthcare in the EU.

Urgency of this work?/ Why this consortium?

Large cohort studies regarding the diagnosis and the management of AIP are lacking. Further, the incidence of this condition increases as recent data show. For example, in the USA are expected for 2020, 4504 placenta accretas and 130 maternal deaths per year, additionally9. Via IS-AIP, the EU can benefit now from a network of at least 13 expertise centers all over Europe able to improve knowledge and management and to inform and sensitize the healthcare decision makers.

 

________________________________________________________________________________________________________________________ 

On behalf of EW-AIP the following paper has been recently published: 

Ultrasound Obstet Gynecol. 2016 Mar;47(3):271-5. doi: 10.1002/uog.14952.
Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP).

Pubmed link

  

With the contribution of EW-AIP the following paper has been recently published: 

Ultrasound Obstet Gynecol. 2016 Mar;47(3):276-8. doi: 10.1002/uog.15810.
Pro forma for ultrasound reporting in suspected abnormally invasive placenta (AIP): an international consensus.

Pubmed link 

 ________________________________________________________________________________________________________________________  

 References

1. Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical managment of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010; 202:38 e1-9  

2. Miller DA, Chollet JA, Goodwin TM. Clinicla risk factors for placenta-previa accreta- Am J Obstet Gynecol 1997; 177:210-4

3. Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 2007;62:529-39.

4. Resnik R, Lockwood C, Levine D. Diagnosis and management of placenta accreta. In:UpToDate. Waltham, MA, 2011: UpToDate, Basow, DS (Ed), 2011.

5. Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol 2008;61:1243-6.

6. Tikkanen M, Paavonen J, Loukavaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011;90:1140-6.

7. Befort MA. Placenta accreta. Am J Obstet Gynecol 2010;203:430-9.

9. Solheim KN, Esakoff TF, Litle SE, Cheng YW, Soarks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neona 2011.

 

Special Issue on AIP in Acta Obstetricia et Gynecologica Scandinavica April 2013!