Trends, Characteristics, and Outcomes of Placenta Accreta Spectrum: A National Study in the United States

Abstract

Placenta accreta spectrum (PAS) describes the phenomenon wherein the trophoblastic placental tissue morbidly attaches to the myometrium of the gravid uterus, preventing normal detachment and causing morbidity. Depending on the degree of invasion, PAS is categorized as accreta if attached to the myometrium without decidua, increta if invasion occurs into the myometrium, and percreta if invasion through the myometrium into surrounding organs occurs. The incidence of PAS has increased over the last few decades; however, national statistics related to pregnancies with PAS and outcomes related to PAS are limited.

Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum

“…The identification of these outcome measures, except for death, was based on the ICD-10 as described previously. 4 Information on death is available in the NIS programme. The NIS programme captures the surgical outcomes measured during the index admission.…”

“…The ICD-10 codes and grouping allocation for the clinical information followed the same pattern as a previous analysis that used the same data source. 4 (1) Patient baseline demographics included age, year, admission type, race/ethnicity, primary expected payer, median household income, and obesity. Obesity was classified using the CDC classification system (body mass index ≥30 kg/m 2 ).…”

“…1,2 PAS is rare, but its incidence has increased over the past decades. 3,4 Women with PAS frequently undergo surgical treatment via hysterectomy at the time of caesarean delivery (caesarean hysterectomy). 1,2 Caesarean hysterectomy for PAS is a complex surgery that is associated with significant maternal morbidity and mortality.…”

“…1,2 Haemorrhage, shock, coagulopathy, and injury to the organs adjacent to the uterus are common surgical complications, and surgical mortality is approximately 0.3%. 1,2,4 For this reason, referring women with PAS to hospitals that meet the Centre-of-Excellence criteria, including a multidisciplinary team approach, is key to improving surgical outcomes. 5 In addition to the referral to a Centre-of-Excellence for PAS, one strategy to improve the outcomes of caesarean hysterectomy for PAS is to centralise the surgeries to highvolume centres.…”

Potential Serum Biomarkers in Prenatal Diagnosis of Placenta Accreta Spectrum

“…(ii) Hysterectomy and urinary tract injury are other common outcomes, which may have a profound influence on women's long-term life quality. All these terrible outcomes harm both the women's mental and physical health ( 4 ).…”