The Society for Pediatric Pathology Task Force grading system for placenta accreta spectrum and its correlation with clinical outcomes

Salmanian, Bahram; Shainker, Scott A.; Modest, Anna M.; Castro, Eumenia; Seaman, Rachel D.; Meshinchiasl, Nazlisadat; Hessami, Kamran; Brown, Alec; Tounsi, Sarah; Shamshirsaz, Amir A.; Fox, Karin A.; Clark, Steven L.; Belfort, Michael A.; Shamshirsaz, Alireza A.

doi:10.1016/j.ajog.2022.02.002

Cited by 8 publications

(8 citation statements)

References 18 publications

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Section: Diagnosis Of Placenta Accreta Spectrummentioning

confidence: 99%

“…We recommend the usage of this new histologic grading system because it is intended to deal with the clinical and histopathologic divergences in PAS literature by distinguishing adherent and invasive placentation and to standardize the communication between community clinics and specialty hospitals. 4,7 Conclusions PAS is becoming a common emergency disease in current obstetrics due to the growing number of cesarean sections, placenta previa, and assisted reproductive technology (ART). The early and precise diagnosis of PAS is imperative to prevent maternal intrapartum or postpartum bleeding complications.…”

Section: Basal Plate Myometrium Fibers (Bpmf)mentioning

confidence: 99%

“…5 The standardized clinical classification and new terminology of PAS including all grades of abnormal placentation descriptively substituted the traditional categorical nomenclature (placenta accreta, increta, percreta) with a pathologic grading classification recently proposed by FIGO (International Federation of Gynaecology and Obstetrics) (Figure 1). 4,6,7 PAS was first reported in 1927 by Irving et al with an incidence of only 0.12 in 1000 women. 1 In recent years, its incidence in the United States has raised about 13-fold due to a rapidly ascending rate of cesarean deliveries from 5.8% to 32.9%.…”

Section: Introductionmentioning

confidence: 99%

Figure 1 Histologic grading classification of placenta accreta spectrum (PAS) disorders. (PAS Grade 1) Abnormally invasive placenta (placenta accreta).…”

Section: Introductionmentioning

confidence: 99%

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Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

Arakaza¹,

Zou²,

Zhao³

2023

IJWH

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Background Placenta accreta spectrum (PAS) is the most common obstetric complication in current obstetrics in which the placenta is fully or partially attached to the uterine myometrial layer at delivery. This is commonly due to the deficiency of the uterine interface between the uterine endometrial and myometrial layers leading to abnormal decidualization at the uterine scar area, which permits the abnormally placental anchoring villous and trophoblasts, deeply invade the myometrium. The prevalence of PAS is globally at rising trends every day in modern obstetrics originally due to the high increasing rate of cesarean sections, placenta previa, and assisted reproductive technology (ART). Thus, the early and precise diagnosis of PAS is imperative to prevent maternal intrapartum or postpartum bleeding complications. Objective The main aim of this review is to debate the current challenges and controversies in the routine diagnosis of PAS diseases in obstetrics. Data Source We retrospectively reviewed the recent articles on different methods of diagnosing PAS in PubMed, Google Scholar, Web of Science, Medline, Embase, and other website databases. Results Despite that, the standard ultrasound is a reliable and key tool for the diagnosis of PAS, the lack of ultrasound features does not exclude the diagnosis of PAS. Therefore, clinical assessment of risk factors, MRI tests, serological markers, and placental histopathological tests are also indispensable for the prediction of PAS. Previously, limited studies reached a high sensitivity rate of diagnosis PAS in appropriate cases, while many studies recommended the inclusion of different diagnosis methods to improve the diagnosis accuracy. Conclusion A multidisciplinary squad with well-experienced obstetricians, radiologists, and histopathologists should be involved in the establishment of the early and conclusive diagnosis of PAS.

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Section: Diagnosis Of Placenta Accreta Spectrummentioning

confidence: 99%

Section: Basal Plate Myometrium Fibers (Bpmf)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Figure 1 Histologic grading classification of placenta accreta spectrum (PAS) disorders. (PAS Grade 1) Abnormally invasive placenta (placenta accreta).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

Arakaza¹,

Zou²,

Zhao³

2023

IJWH

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“…The most common risk factors for PAS are placenta previa and prior cesarean delivery 10 . This diagnostic paradigm is, however, insensitive, as one-third to one-half of PAS cases remain undiagnosed prior to delivery, and this strategy performs poorly among patients without identified clinical risk factors 7 – 9 , 11 . Given these limitations, a readily accessible PAS biomarker would be of unparalleled clinical utility to inform a woman’s risk of PAS, particularly in low resource and rural settings without specialized ultrasound services.…”

Section: Introductionmentioning

confidence: 99%

Circulating microparticle proteins predict pregnancies complicated by placenta accreta spectrum

Gumusoglu

Cantonwine

et al. 2023

Sci Rep

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Placenta accreta spectrum (PAS) is characterized by abnormal attachment of the placenta to the uterus, and attempts at placental delivery can lead to catastrophic maternal hemorrhage and death. Multidisciplinary delivery planning can significantly improve outcomes; however, current diagnostics are lacking as approximately half of pregnancies with PAS are undiagnosed prior to delivery. This is a nested case–control study of 35 cases and 70 controls with the primary objective of identifying circulating microparticle (CMP) protein panels that identify pregnancies complicated by PAS. Size exclusion chromatography and liquid chromatography with tandem mass spectrometry were used for CMP protein isolation and identification, respectively. A two-step iterative workflow was used to establish putative panels. Using plasma sampled at a median of 26 weeks’ gestation, five CMP proteins distinguished PAS from controls with a mean area under the curve (AUC) of 0.83. For a separate sample taken at a median of 35 weeks’ gestation, the mean AUC was 0.78. In the second trimester, canonical pathway analyses demonstrate over-representation of processes related to iron homeostasis and erythropoietin signaling. In the third trimester, these analyses revealed abnormal immune function. CMP proteins classify PAS well prior to delivery and have potential to significantly reduce maternal morbidity and mortality.

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Modified one‐step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single‐center retrospective analysis based on 619 Vietnamese pregnant women

Vuong,

Pham,

Pham

et al. 2023

Intl J Gynecology & Obste

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ObjectivesTo compare maternal outcome measures in surgical management of placenta accreta spectrum (PAS)—the modified one‐step conservative uterine surgery (MOSCUS), a new approach at Tu Du Hospital in Vietnam, versus cesarean hysterectomy, and to identify factors that appear to contribute to the successful outcome of the MOSCUS.MethodsThis retrospective study was conducted at Tu Du Hospital in southern Vietnam between January 2019 and December 2020. The study enrolled all pregnant women at more than 28 weeks of pregnancy with a diagnosis of PAS who underwent either a cesarean hysterectomy or a uterus‐preserving approach using the MOSCUS method.ResultsThe prevalence of PAS at our single tertiary referral hospital was 0.4% (619 PAS cases/132 518 births) in 2 years. Among 296 patients, the surgical time duration, estimated blood loss, and red blood cell transfusion in the MOSCUS group (n = 217) were all significantly less than in the cesarean hysterectomy group (n = 79) (152.72 ± 42.23 vs 185.13 ± 58.22 min, 1000 vs 1500 mL, and 500 vs 710 mL, respectively). Intraoperatively, the rate of visceral injuries in the hysterectomy group was higher than that in the MOSCUS group (P < 0.001). However, the rate of postoperative infection was higher in the MOSCUS group than in the cesarean hysterectomy group (P = 0.012). Of a total of 217 cases managed using the MOSCUS management, 24 required a secondary hysterectomy; the success rate was 88.9% (95% confidence interval [CI] 84.3%–93.1%). Some of the primary factors associated with the success of MOSCUS included maternal age less than 35 years, planned surgery, severity of PAS, and estimated blood loss during surgery (odds ratio [OR] 5.16, 95% CI 1.96–13.59; OR 3.05, 95% CI 1.08–8.62; OR 3.62, 95% CI 1.19–10.98; and OR 49.66, 95% CI 11.16–221.02, respectively; P < 0.05).ConclusionMOSCUS is an acceptable alternative to cesarean hysterectomy in many patients diagnosed with PAS. This new surgical management of PAS resulted in the preservation of the uterus, and a favorable outcome in nearly 9 out of 10 pregnant women. We believe that MOSCUS can be safely offered for the management of PAS in referral hospital settings.

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The Society for Pediatric Pathology Task Force grading system for placenta accreta spectrum and its correlation with clinical outcomes

Cited by 8 publications

References 18 publications

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

Circulating microparticle proteins predict pregnancies complicated by placenta accreta spectrum

Modified one‐step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single‐center retrospective analysis based on 619 Vietnamese pregnant women

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