General
Diagnosis
Management I
Management II
Miscellaneous
100
This is the definition of placenta accreta syndrome
What is abnormal trophoblast invasion into the myometrium of the uterine wall
100
These are the available imaging modalities to eval. for possible PAS
What are ultrasound and MRI
100
This is the recommended time of delivery for patients with PAS
What is 34w-35w6d
100
This is the management of percreta with bladder invasion
What is cystoscopy or intentional cystotomy at surgery
100
These are candidates who should be screened for PAS
Who are women with placenta previa or low anterior placenta and prior uterine surgery
200
This is the clinical presentation of PAS
What is hemorrhage at the time of attempted manual placental separation, sometimes antenatal bleeding in the setting of placenta previa
200
This is the preferred imaging modality for the initial eval. of possible PAS
What is ultrasound
200
This is the most generally accepted method of delivery
Cesarean & hysterectomy
200
True or false: Prophylactic oxytocin is routinely administered after the infant is delivered
What is false!
200
True or false: prophylactic endovascular intervention (e.g. uterine artery embolization and/or balloon catheter in both internal iliac arteries) reduce morbidity and mortality
What is false!
300
These are the ranges of placenta accreta spectrum
What is placenta accreta, placenta increta, placenta percreta
300
True or false: MRI is better than US in diagnosis of PAS
What is false!
300
These are the conservative management of PAS
What are uterine conservation with placenta left in situ or focal placenta resection
300
This is the management of unexpected PAS at C-section when patient is stable
What is packing the uterus until appropriate personnel are available vs. closing the abdomen and transfer if personnel and resources cannot be assembled
300
These are the characteristics of PAS seen at C-section
What are 1) placental tissue invading the lower uterine segment, serosa, or bladder; 2) increased and tortuous vascularity along the lower uterine segment; 3) Bluish/purple and distended lower uterine segment
400
This is the hypothesis re. etiology of placenta accreta
What is defect of the endometrial–myometrial interface, usually in the area of a uterine scar, leading to abnormal decidualization and abnormally deep trophoblast infiltration
400
These are situations when MRI is useful
What are posterior placenta previa and suspected percreta
400
These are potential complications of conservative management (list 4)
What are hemorrhage, sepsis, secondary hysterectomy and death
400
This is the management of PAS discovered at C-section and patient is not stable
What is delivery through hysterotomy far away from placenta, closing the hysterotomy and leaving placenta undisturbed until additional help is available
â—Ź
400
These are additional lab findings supporting diagnosis of PAS
What are elevated maternal serum AFP and hematuria
500
These are the risk factors of placenta accreta (list 5)
What is prior C-section, prior uterine surgeries or pelvic irradiation, placenta previa, multip, AMA, history of manual removal of the placenta, postpartum endometritis, infertility and/or infertility procedures
500
Once PAS is confirmed, this is the time when one should repeat ultrasound
What is 32-34 weeks
500
These are potential candidates for conservative management of PAS
Who are patients who want to preserve fertility, despite potential risks, when placental resection is possible because of focal accreta or fundal/posterior placenta, when hysterectomy is thought to have an unacceptably high risk
500
These are the people who should be involved/consulted near time of delivery (list 5)
Who are MFM, expert pelvic surgeon, urology (if bladder involved), NICU, anesthesia, blood bank, IR, ICU
500
These are the components of prenatal care one should consider during prepartum period (list 5)
What are correction of iron deficiency anemia, antenatal steroids between 23 and 34 weeks, RhoGAM if vaginal bleeding and pt is Rh-, avoidance of pelvic examination and rigorous physical activity, consideration of hospitalization in the third trimester if symptomatic or pt living at a remote distance from a center capable of managing PAS.