Prenatal diagnosis of placenta accreta spectrum

Conturie, Charlotte L.; Lyell, Deirdre J.

doi:10.1097/gco.0000000000000773

Cited by 11 publications

(8 citation statements)

References 80 publications

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“…Ultrasound (US) examination and magnetic resonance imaging (MRI) interpretation for accurate antenatal diagnosis should be done by an experienced radiologist. US is usually the rst imaging modality for the prenatal diagnosis of PAS and can be highly accurate when performed by a provider with expertise [19]. MRI is usually performed when PAS is suspected by US studies mostly with the aim of evaluating the extent of placental invasion, specially for those cases of posterior lying placenta.…”

Section: Discussionmentioning

confidence: 99%

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

Vettorazzi,

Farenzena,

Perez

et al. 2023

Preprint

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Purpose Placenta accreta spectrum disorder (PAS) is a pathological condition in which placenta abnormally adheres to or invades the myometrium. PAS has a high risk of complications, especially peripartum bleeding, which can be associated with several maternal and neonatal adverse outcomes. Our goal is to determine maternal and fetal outcomes in cases of PAS managed by a multidisciplinary team (MDT). Methods This is a retrospective cohort study that included all cases of PAS managed by a MDT between January 2016 and December 2022. Maternal and neonatal outcomes were analyzed for each case. Results There were 102 cases of PAS managed by a MDT during the study period. Maternal age average was 35.5 years, 75.4% had at least one prior cesarean section and 55.8% had placenta previa. 54.9% were diagnosed with placenta accreta, 20.5% with placenta increta and 24.5% with placenta percreta. Hysterectomy was performed in 55.8% of the cases, and in 87.7% of them placenta was left in situ. Blood products transfusion was necessary in 24.5% of the cases, with a mean number of 2 red blood cells concentrates. Intensive care unit admission rate after surgery was 8.8% and no maternal death occurred. Conclusions Although PAS is a condition associated with high morbidity and mortality, this study demonstrates lower rates of maternal complications than reported in literature. PAS management should be based in protocols, and pregnancy interruption should be performed in centers of excellence with an experienced and trained MDT, making it possible to reduce maternal morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

“…PAS is an infrequent disorder and the number of cases described is still small. Nevertheless, this report describes one of the larger published case series until the present moment [13,[17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

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

Vettorazzi,

Farenzena,

Perez

et al. 2023

Preprint

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“…Damage to the endometrium is thought to prevent normal decidualization, causing abnormally deep placental villi and trophoblastic invasion and thus leading to the development of PAS [ 10 ]. Other risk factors for PAS include placenta previa, prior cesarean section, intrauterine procedures, use of assisted reproductive technology, a history of PAS, a history of PPH, and twin gestation [ 11 ]. Other reports have indicated that smoking is a risk factor for PAS [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Unexpected uterine body placenta accreta spectrum with placenta previa in a subsequent pregnancy after uterine artery embolization: a case report

Sugai

Yamawaki

Haino

et al. 2022

BMC Pregnancy Childbirth

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Background A subsequent pregnancy after uterine artery embolization (UAE) raises several concerns, one of which is placenta accreta spectrum (PAS). Placenta previa is the strongest risk factor for PAS, which is most likely to occur in the lower uterine segment. PAS without placenta previa (i.e., uterine body PAS) is considered relatively rare. Case presentation A 35-year-old woman, gravida 2 para 1, had undergone UAE for postpartum hemorrhage due to uterine atony after vaginal delivery in her previous pregnancy. She developed placenta previa during her subsequent pregnancy and was therefore evaluated for PAS in the lower uterine segment. On the basis of examination findings, we considered PAS to be unlikely. During cesarean section, we found that the placenta was not detached from the uterine body, and the patient was determined to have uterine body PAS. Ultimately, a hysterectomy was performed. Conclusions PAS can occur in a subsequent pregnancy after UAE. When a subsequent pregnancy after UAE is accompanied by placenta previa, it is important to maintain a high index of suspicion of uterine body PAS without being misled by the presence of placenta previa.

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“… 3 In fact, the presence of placenta previa (PP) and a history of previous cesarean deliveries are the two major risk factors for PAS, and the incidence increases linearly with the number of repeated cesarean deliveries or hysterotomies. 4 , 5 PP at one stage was considered necessary in PAS diagnosis. 6 Such antenatal situations (PP and PAS) could be associated with high maternal and neonatal morbidity and even mortality.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive MRI in the diagnosis of placenta accreta spectrum in major placenta previa: incidence, risk factors, and maternal morbidity

Shaamash,

AlQasem,

Al Ghamdi

et al. 2023

Ann Saudi Med

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BACKGROUND: Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis. OBJECTIVES: Evaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP. DESIGN: A 10-year retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS AND METHODS: We report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US). MAIN OUTCOME MEASURES: Risk factors for PAS in major PP and maternal complications. SAMPLE SIZE: 299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding. CONCLUSION: MRI may be a valuable adjunct in the evaluation of PAS in major PP, but not as a substitute for US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or suspected deep/extra-uterine extension on US. LIMITATION: Single center, small sample size, lack of complete histopathological diagnosis. CONFLICT OF INTEREST: None.

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Prenatal diagnosis of placenta accreta spectrum

Cited by 11 publications

References 80 publications

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

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

Unexpected uterine body placenta accreta spectrum with placenta previa in a subsequent pregnancy after uterine artery embolization: a case report

Adjunctive MRI in the diagnosis of placenta accreta spectrum in major placenta previa: incidence, risk factors, and maternal morbidity

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