FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology,

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

“…The low incidence of full‐thickness myometrial scarring may explain why very few cases of invasive placentation were reported before the 1950s, when cesarean deliveries became safer and therefore increasingly common. There is now compelling epidemiological evidence that accreta placentation has become essentially an iatrogenic condition, secondary to the modern‐era cesarean section epidemic . In early pathologic studies, the distribution of adherent placenta accreta was found to be 69.5% whereas invasive placenta accreta represented 30.5% of all cases accreta placentation, respectively .…”

“…There is now compelling epidemiological evidence that accreta placentation has become essentially an iatrogenic condition, secondary to the modern‐era cesarean section epidemic . In early pathologic studies, the distribution of adherent placenta accreta was found to be 69.5% whereas invasive placenta accreta represented 30.5% of all cases accreta placentation, respectively . The incidence of invasive cases has increased in the last two decades, but accurate data are limited due to wide variation in the methodology used in cohort studies.…”

“…They also showed that different grades of the placenta accreta spectrum (PAS) can coexist in the same specimens and that an accreta area can be focal or extended (diffuse). This remains the most comprehensive and inclusive description of placenta accreta published so far, and has been incorporated into the recent International Federation of Gynecology and Obstetrics (FIGO) guidelines and other publications …”

“…Similar to other pathologic conditions, histopathology is now widely considered as the gold standard modality recommended to confirm clinical diagnosis of PAS, but it is often unavailable in adherent accreta or conservatively managed cases . Moreover, unlike cancer staging, retrospective clinical and/or pathological grading of PAS has no direct long‐term impact on the life of the patient.…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction,

“…It should be noted that changes in the incidence of PAS disorders secondary to increased cesarean delivery rates may be delayed by up to 10 years, depending on birth rates and interpregnancy intervals, which vary in different parts of world. For the USA alone, it was estimated in 2011 that, if the cesarean delivery rate continues to increase as it has done before, by 2020 the cesarean delivery rate will be over 50% and there will be an additional 4504 annual cases of PAS disorders and 130 maternal deaths due to its complications . Thus, it is not surprising that 80 years later, more than 90% of women presenting with a placenta accreta have had at least one prior cesarean delivery …”