- The International Society for Abnormally Invasive Placenta (AIP) lists recommendations for the management of AIP.
Why this matters
- The incidence of AIP is rising as a result of rising rates of cesarean delivery.
- Main recommendations:
- Outpatient management is acceptable if asymptomatic and patient can rapidly return to hospital.
- Optimize hemoglobin levels.
- Timing of delivery depends upon the situation; planned delivery around 34 weeks should be considered.
- The use of antenatal steroids should be individualized.
- Routine preoperative cystoscopy, ureteral stents, or prophylactic arterial balloon catheters not recommended.
- Dorsal lithotomy position recommended to facilitate manipulation of cervix due to high risk for hysterectomy.
- Vertical skin incision is not helpful.
- Avoiding placental transection helpful to reduce blood loss; intraoperative ultrasound scan should be used when possible to locate placenta.
- Prophylactic uterotonics should not be given immediately after delivery of the infant.
- Expectant management (leaving placenta untouched) is successful in 60%-93%, but 6% have risk for severe maternal morbidity; methotrexate and prophylactic uterine artery embolization are not recommended.
- Local resection may be considered.
- Type of hysterectomy (total vs subtotal) should be individualized.
- Systematic review and expert recommendations.
- Funding: None.
- Expert opinion based on limited research, recommendations may change.