Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Background: Timing for planned delivery in cases with diagnosed PAS disorder is a point of controversy. It is challenging to decide an optimal gestational age from both the maternal and foetal perspective. Various reports recommending planned delivery at gestational age from 34GW to 37GW. The earlier the gestational age the less the risk of emergency unscheduled delivery on one hand accompanied by an elevate neonatal risks of prematurity on the other, While delivery at later gestational age reduce neonatal risks but increase the likelihood of unscheduled delivery. Study design and methods: The study included initially 60 patients with confirmed ultrasonography diagnosis of placenta accreta spectrum disorder by single expert sonographer in placental disorders Candidates were recruited and electronically randomized into either; Group A (will be scheduled for delivery at 35+0 - 35+6 GW) or Group B (will be scheduled for delivery at 36+0 - 36+6 GW) during the course of the study, 7 patients decided to withdraw from the study, All the 7 patients were excluded. Finally, 53 patients were enrolled, and their data were analyzed and incorporated in the study. Results: The demographic data for candidates in group A and B were comparable with no statistical significant difference observed, 17% of recruited cases required unscheduled delivery. The outcome of both random groups A and B were comparable with no significant difference in terms of the proportion of cases requiring unscheduled deliver, maternal outcome nor fetal outcome.The indications of unscheduled delivery were 56% due to antepartum hemorrhage, 33% due to uterine contractions and 11% due rupture of membranes (ROM) Observing the maternal and fetal outcomes of both scheduled and unscheduled deliveries show superiority of scheduled planned surgery over unscheduled emergency surgery in in terms of maternal and fetal outcomes

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