Placenta Accreta Spectrum

Abstract

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta to the uterine myometrium, including the placenta accreta, increta, and percreta. The incidence of PAS is rising primarily because of an increase in related risk factors, such as the rate of cesarean deliveries and pregnancies resulting from assisted reproductive technology. The maternal risks associated with PAS are significant, including hemorrhage, hysterectomy, and death. Fetal and neonatal risks are primarily the result of premature delivery. Antenatal diagnosis via ultrasonography and magnetic resonance imaging remains imperfect. Management of PAS varies, however, and there is a clear improvement in maternal outcomes with an antenatal diagnosis compared with unexpected diagnosis at the time of delivery. Studies that evaluate the balance between maternal and fetal/neonatal risks of expectant management versus preterm delivery have found that planned delivery between 34 and 35 weeks’ gestation optimizes outcomes. Multidisciplinary PAS care teams have become the norm and recommended approach to management, given the complexity of caring for this obstetrical condition. Although significant advances have been made over the years, large knowledge gaps remain in understanding the pathophysiology, diagnosis, and clinical management.

The nightmare of obstetricians — the placenta accreta spectrum in primiparous pregnant women

“…When the pregnancy results of primiparous PAS cases were examined in the literature, it was found that only the gestational weeks were lower at birth, which is consistent with the results of the present study [14]. The cause of this is that PAS cases undergo cesarean section at the 34-37 th gestational weeks [23]. For this reason, the newborn birth weights are statistically less and the gestational weeks at birth are lower.…”

Maternal and neonatal outcomes of women diagnosed with Placenta Accreta Spectrum Disorder managed by a standardized Multidisciplinary Team

“…It is one of the main causes of postpartum hemorrhage and is associated with a 40% chance of needing massive transfusion, contributing to high mortality rates [13] Studies show that management by a MTD reduces PAS morbidity, which includes prenatal diagnosis and prenatal care by experienced professionals. A standardized planning prior to labor is mandatory, as well as preparation for performing an elective cesarean section, followed by an immediate hysterectomy if necessary [14][15].…”

Early Detection of Adhesive Placenta Previa in Cesarean Section

“…Patients with a history of previous cesarean delivery and placenta previa previa were examined by antenatal sonography, but a definitive diagnosis was made after delivery [7]. Placenta Acreta Index (PAI) is a value for each sonographic parameter that is used to assess the probability of the extent to which the placenta invades the uterine wall [7]- [9]. Assessment of the PAI score in patients with placenta previa with suspicion of undergoing cesarean section can be a fairly accurate predictor of both sensitivity and specificity for the incidence of placenta accrete [10]- [12].…”