Materiały źródłowe

• #1 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Placenta accreta spectrum (PAS) disorders are considered to be iatrogenic conditions. They are more common in women with previous cesarean deliveries. The incidence and prevalence of PAS disorders continue to rise globally due to the increasing rate of cesarean deliveries. PAS disorders are associated with an increased risk of maternal morbidity and maternal mortality. This activity reviews the evaluation and management of women with PAS disorders and highlights the role of the interprofessional team in the care of patients with this condition. […] In a normal pregnancy, the placenta anchors to decidualized endometrium. The abnormal invasion of placental trophoblasts into the uterine myometrium is called placenta accreta. Based on the degree of myometrial invasion, it is considered a spectrum of disorders, encompassing placenta accreta, placenta increta, and placenta percreta. Placenta accreta spectrum (PAS) disorders are associated with increased maternal morbidity and mortality. Therefore, these patients should be cared for by an interprofessional team.

• #2 Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel | Modern Pathology

  https://www.nature.com/articles/s41379-020-0569-1

  The terminology and diagnostic criteria presently used by pathologists to report invasive placentation is inconsistent and does not reflect current knowledge of the pathogenesis of the disease or the needs of the clinical care team. […] The proposed nomenclature under the umbrella diagnosis of placenta accreta spectrum (PAS) replaces the traditional categorical terminology (placenta accreta, increta, percreta) with a descriptive grading system that parallels the guidelines endorsed by the International Federation of Gynaecology and Obstetrics (FIGO). […] The screening and prenatal diagnosis of PAS is primarily made by ultrasound imaging, sometimes supplemented with MRI. […] Accurate prenatal diagnosis is essential for planning a safe delivery in a center of excellence with a multidisciplinary team and access to adult and neonatal intensive care.

• #3 Classification of Placenta Accreta Spectrum Disorders | Figo

  https://www.figo.org/news/classification-placenta-accreta-spectrum-disorders

  Misdiagnosis and treatment of placenta accreta spectrum (PAS) disorders, a high-risk pregnancy condition that occurs when the placenta grows too deeply into a womans uterine wall, is a significant maternal health challenge. Safe and effective care of a woman with a placenta accreta spectrum disorder depends on timely diagnosis. […] With so many different criteria all purporting to represent placenta accreta spectrum, but without any attempt to differentiate between adherent and invasive forms, it is unsurprising that there is a wide variation in the reported prevalence over the last 30 years. […] In the immediate moment it can be life-threatening, because different forms of placenta accreta spectrum have very different outcomes and require different management, with varying risk of severe bleeding, complications and need for surgical intervention. Placenta accreta disorders have become a leading cause of peripartum hysterectomy, maternal morbidity, and even mortality.

• #4 ACOG SMFM Obstetric Care Consensus #7: Placenta Accreta Spectrum – SMFM Publications and Clinical Guidelines

  https://publications.smfm.org/publications/266-acog-smfm-obstetric-care-consensus-7-placenta-accreta/

  Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. […] Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of placenta accreta spectrum; thus, clinical risk factors remain equally important as predictors of placenta accreta spectrum by ultrasound findings. […] Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. […] The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus(attempts at placental removal are associated with significant risk of hemorrhage).

• #5 Classification of Placenta Accreta Spectrum Disorders | Figo

  https://www.figo.org/news/classification-placenta-accreta-spectrum-disorders

  Misdiagnosis and treatment of placenta accreta spectrum (PAS) disorders, a high-risk pregnancy condition that occurs when the placenta grows too deeply into a womans uterine wall, is a significant maternal health challenge. Safe and effective care of a woman with a placenta accreta spectrum disorder depends on timely diagnosis. […] With so many different criteria all purporting to represent placenta accreta spectrum, but without any attempt to differentiate between adherent and invasive forms, it is unsurprising that there is a wide variation in the reported prevalence over the last 30 years. […] In the immediate moment it can be life-threatening, because different forms of placenta accreta spectrum have very different outcomes and require different management, with varying risk of severe bleeding, complications and need for surgical intervention. Placenta accreta disorders have become a leading cause of peripartum hysterectomy, maternal morbidity, and even mortality.

• #6 Placenta accreta spectrum: Clinical features, diagnosis, and potential consequences – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-the-morbidly-adherent-placenta-placenta-accreta-increta-and-percreta

  Placenta accreta spectrum (PAS) is a general term used to describe abnormal trophoblast invasion into the myometrium, and sometimes to or beyond the serosa. It is clinically important because the placenta does not spontaneously separate at delivery and attempts at manual removal result in hemorrhage, which can be life-threatening and usually necessitates hysterectomy. […] This topic will discuss the clinical features, diagnosis, and potential consequences of PAS. […] The most important risk factor for PAS is a placenta previa after a prior cesarean birth. […] Prenatal diagnosis includes ultrasound findings and the utility of additional imaging techniques such as magnetic resonance imaging (MRI) and three-dimensional power Doppler ultrasound.

• #7 Prepare for the unanticipated: Placenta accreta spectrum

  https://www.contemporaryobgyn.net/view/prepare-for-the-unanticipated-placenta-accreta-spectrum

  Screening for PAS begins with an assessment of risk factors based on patient history. […] Patients with a known placenta previa and prior history of cesarean delivery should undergo sonographic assessment for the evaluation of PAS. […] Ultrasound markers for PAS include placental lacunae, abnormalities of the uteroplacental interface, uterine/placental bulge, bridging vessels, and an exophytic mass. […] Ultrasound has a combined sensitivity based on established markers of 81.1% and specificity of 98.9%. […] Though ultrasound markers are more commonly evaluated in the second and third trimesters, many can also be observed in the first trimester. […] The use of MRI for diagnosis of PAS remains less defined. […] Prenatal diagnosis of PAS is based on suspicion from obtained imaging.

• #8 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. […] Placenta accreta occurs when the placenta grows too deeply into the uterine wall during pregnancy. Scarring in the uterus from a prior C-section or other uterine surgery may play a role in developing this condition. […] If the condition is diagnosed during pregnancy, you’ll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy). […] Occasionally, placenta accreta is detected during a routine ultrasound. […] Placenta accreta is thought to be related to abnormalities in the lining of the uterus, typically due to scarring after a C-section or other uterine surgery. […] The risk of placenta accreta increases with the number of C-sections or other uterine surgeries you’ve had.

• #9

  https://journalonsurgery.org/articles/js-v3-1119.html

  Placenta Accreta Spectrum (PAS) refers to the abnormal invasion of placental villi into the base of the decidua. […] The incidence of this disease has increased tenfold in the past 50 years, mainly considered as the result of the increase of cesarean sections and advanced maternal age, and was expected to keep on increasing over time. […] For gravidas with history of cesarean section, the risk of PAS is significantly higher than that without, and the incidence of PAS increases with the number of cesarean sections. […] When accompanied by placenta previa, the occurrence of PAS is markedly increased. […] Advanced age is also a risk factor for PAS. […] The risk of PAS in older pregnant women ( 35 years old) is 2.1 times that in women aged 20~34 years. […] PAS patients are prone to massive bleeding, which not only has a great demand for blood transfusion, but also leads to the death of pregnant women, increases the probability of hysterectomy, and prolongs the hospital stay, leading to many adverse outcomes.

• #10 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  If the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus, you’re at increased risk of placenta accreta. […] Placenta accreta is more common in women older than 35. […] The risk of placenta accreta increases as your number of pregnancies increases. […] Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery.

• #11

  https://journalonsurgery.org/articles/js-v3-1119.html

  Placenta Accreta Spectrum (PAS) refers to the abnormal invasion of placental villi into the base of the decidua. […] The incidence of this disease has increased tenfold in the past 50 years, mainly considered as the result of the increase of cesarean sections and advanced maternal age, and was expected to keep on increasing over time. […] For gravidas with history of cesarean section, the risk of PAS is significantly higher than that without, and the incidence of PAS increases with the number of cesarean sections. […] When accompanied by placenta previa, the occurrence of PAS is markedly increased. […] Advanced age is also a risk factor for PAS. […] The risk of PAS in older pregnant women ( 35 years old) is 2.1 times that in women aged 20~34 years. […] PAS patients are prone to massive bleeding, which not only has a great demand for blood transfusion, but also leads to the death of pregnant women, increases the probability of hysterectomy, and prolongs the hospital stay, leading to many adverse outcomes.

• #12 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. […] Placenta accreta occurs when the placenta grows too deeply into the uterine wall during pregnancy. Scarring in the uterus from a prior C-section or other uterine surgery may play a role in developing this condition. […] If the condition is diagnosed during pregnancy, you’ll likely need an early C-section delivery followed by the surgical removal of your uterus (hysterectomy). […] Occasionally, placenta accreta is detected during a routine ultrasound. […] Placenta accreta is thought to be related to abnormalities in the lining of the uterus, typically due to scarring after a C-section or other uterine surgery. […] The risk of placenta accreta increases with the number of C-sections or other uterine surgeries you’ve had.

• #13 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  If the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus, you’re at increased risk of placenta accreta. […] Placenta accreta is more common in women older than 35. […] The risk of placenta accreta increases as your number of pregnancies increases. […] Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery.

• #14

  https://journalonsurgery.org/articles/js-v3-1119.html

  Placenta Accreta Spectrum (PAS) refers to the abnormal invasion of placental villi into the base of the decidua. […] The incidence of this disease has increased tenfold in the past 50 years, mainly considered as the result of the increase of cesarean sections and advanced maternal age, and was expected to keep on increasing over time. […] For gravidas with history of cesarean section, the risk of PAS is significantly higher than that without, and the incidence of PAS increases with the number of cesarean sections. […] When accompanied by placenta previa, the occurrence of PAS is markedly increased. […] Advanced age is also a risk factor for PAS. […] The risk of PAS in older pregnant women ( 35 years old) is 2.1 times that in women aged 20~34 years. […] PAS patients are prone to massive bleeding, which not only has a great demand for blood transfusion, but also leads to the death of pregnant women, increases the probability of hysterectomy, and prolongs the hospital stay, leading to many adverse outcomes.

• #15 Placenta accreta – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/symptoms-causes/syc-20376431

  If the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus, you’re at increased risk of placenta accreta. […] Placenta accreta is more common in women older than 35. […] The risk of placenta accreta increases as your number of pregnancies increases. […] Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery.

• #16 Antenatal diagnosis of placenta accreta spectrum after in vitro fertilization-embryo transfer: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-021-88551-7

  Increasing evidence suggests a relationship between in vitro fertilization-embryo transfer (IVF-ET) and placenta accreta spectrum (PAS). […] This study aimed to review the diagnostic accuracy of PAS after IVF-ET and to explore the relationship between IVF-ET pregnancy and PAS. […] The antenatal diagnosis of PAS after IVF-ET was significantly lower than that of PAS with spontaneous conception (22.2% versus 94.7%, P0.01; 12.9% versus 46.9%, P0.01). […] The risk of PAS was significantly higher in women who conceived with IVF-ET than in those with spontaneous conception (odds ratio [OR]: 5.03, 95% confidence interval [CI]: 3.34-7.56, P0.01). […] Notably, frozen ET with hormone replacement cycle was significantly associated with the prevalence of PAS compared to frozen ET with normal ovulatory cycle (OR: 5.76, 95%CI 3.12-10.64, P0.01).

• #17 National Accreta Foundation — What Do Accreta Patients Need to Know? | Placenta Accreta Patient FAQ | National Accreta Foundation

  https://www.preventaccreta.org/faq

  Placenta accreta spectrum is becoming increasingly common and is associated with significant morbidity and mortality. […] Ultrasound is the primary diagnostic tool for accreta, with most cases identified in the second and third trimesters, although it’s important to know that ultrasound is not perfect. […] Diagnosis of accreta is a critical first step in obtaining proper level care. […] The ACOG SMFM Accreta Care Consensus states: Conservative management or expectant management should be considered only for carefully selected cases of placenta accreta spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational. […] The diagnosis of placenta accreta spectrum (PAS) can be difficult and sometimes uncertain.

• #18 Prepare for the unanticipated: Placenta accreta spectrum

  https://www.contemporaryobgyn.net/view/prepare-for-the-unanticipated-placenta-accreta-spectrum

  Screening for PAS begins with an assessment of risk factors based on patient history. […] Patients with a known placenta previa and prior history of cesarean delivery should undergo sonographic assessment for the evaluation of PAS. […] Ultrasound markers for PAS include placental lacunae, abnormalities of the uteroplacental interface, uterine/placental bulge, bridging vessels, and an exophytic mass. […] Ultrasound has a combined sensitivity based on established markers of 81.1% and specificity of 98.9%. […] Though ultrasound markers are more commonly evaluated in the second and third trimesters, many can also be observed in the first trimester. […] The use of MRI for diagnosis of PAS remains less defined. […] Prenatal diagnosis of PAS is based on suspicion from obtained imaging.

• #19 Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05675-6

  To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). […] The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. […] The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. […] The accuracy of 2D ultrasound was reported in 50 studies that involved 5406 women, and 1773 of them were confirmed to have PAS through pathological examination. The overall sensitivity was 0.8703 (0.825 to 0.9051); the specificity was 0.8634 (0.8142 to 0.9012), with a -0.2348 negative correlation between them. […] The accuracy of 3D ultrasound was reported in 3 studies that involved 447 women, and 134 of them had a confirmed diagnosis of PAS. The overall estimates of sensitivity and specificity were 0.728 (0.3790.921) and 0.969 (0.7640.997), respectively. […] Our systematic review confirmed the value of ultrasound in diagnosis of PAS among women having a low lying or placenta previa with previous uterine scars. Its use is mandatory as it represents a low cost, readily available tool for prenatal diagnosis of PAS.

• #20 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Ultrasound has reported sensitivity 90% and specificity 96% in the diagnosis of PAS. […] The above listed sonographic signs should not be used independently to diagnose PAS, as they individually may have low sensitivity and specificity for PAS. […] Studies have shown varying sensitivity rates using ultrasound for the prenatal diagnosis of PAS; these sensitivities vary, but range from 70-90%. […] The majority of published guidelines recommend the use of ultrasound for diagnosis of PAS, with magnetic resonance imaging (MRI) use as an adjunct if needed. […] The study concluded that, given the high cost and limited clinical value, MRI should not be routinely used as an adjunct to ultrasound in the detection of PAS.

• #21 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  The most important risk factor implying PAS is placenta previa. This condition increases the risk of development of this anomaly and associated complications to the greatest degree. […] The presence or absence of a specific symptom mainly depends on the ultrasound operators interpretation. […] To improve the ultrasound scan sensitivity, it is recommended to perform the scan with the urinary bladder filled and additionally using the vaginal probe and the Doppler technique. […] The role of MRI in PAS diagnostics is less established. Limitations in the MRI application result from a lower availability of this method, higher costs, and fewer specialists experienced in interpreting MRI images of the placenta. […] In treating patients with suspected PAS, the appropriate preparation of the health care system, medical care centres, or clinical teams is more important than the experience and skills of an individual specialist.

• #22 Placenta accreta: Diagnosis, management and the molecular biology of the morbidly adherent placenta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5424888/

  Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and intra and post-partum complications. Ultrasound is critical for diagnosis and MRI is a complementary tool when the diagnosis is uncertain. […] The prenatal diagnosis of accreta is crucial and is associated with a significant reduction in maternal blood loss and of post partum complications. Ultrasound findings suggestive of accreta include placental lacunae, myometrial thinning to less than 1 mm, the loss of a placental-uterine interface and an abnormal uterine bladder interface. The use of color and 3D Doppler ultrasound is also helpful in diagnosing placenta accreta. MRI may be helpful when the diagnosis is uncertain, if posterior invasion is concerned, or if percreta/invasion of other surrounding organs is suspected.

• #23 Prepare for the unanticipated: Placenta accreta spectrum

  https://www.contemporaryobgyn.net/view/prepare-for-the-unanticipated-placenta-accreta-spectrum

  Screening for PAS begins with an assessment of risk factors based on patient history. […] Patients with a known placenta previa and prior history of cesarean delivery should undergo sonographic assessment for the evaluation of PAS. […] Ultrasound markers for PAS include placental lacunae, abnormalities of the uteroplacental interface, uterine/placental bulge, bridging vessels, and an exophytic mass. […] Ultrasound has a combined sensitivity based on established markers of 81.1% and specificity of 98.9%. […] Though ultrasound markers are more commonly evaluated in the second and third trimesters, many can also be observed in the first trimester. […] The use of MRI for diagnosis of PAS remains less defined. […] Prenatal diagnosis of PAS is based on suspicion from obtained imaging.

• #24 Placenta accreta spectrum – Wikipedia

  https://en.wikipedia.org/wiki/Placenta_accreta_spectrum

  Placenta accreta spectrum (PAS) is a medical condition that occurs when all or part of the placenta attaches abnormally to the myometrium (the muscular layer of the uterine wall) during pregnancy. […] When the antepartum diagnosis of placenta accreta is made, it is usually based on ultrasound findings in the second or third trimester. Sonographic findings that may be suggestive of placenta accreta include: Loss of normal hypo-echoic retroplacental zone, Multiple vascular lacunae (irregular vascular spaces) within placenta, giving „Swiss cheese” appearance, Blood vessels or placental tissue bridging uterine-placental margin, myometrial-bladder interface, or crossing the uterine serosa, Retroplacental myometrial thickness of 1 mm, Numerous coherent vessels visualized with 3-dimensional power Doppler in basal view.

• #25 Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05886-x

  Combined evaluation of multiple features is likely to improve the accuracy of ultrasound diagnosis of PAS. […] In the present study, the scoring system used an objective and reasonable approach. […] The presence of placental lacunae, which appear as irregular ellipsoid shapes on ultrasound, is considered a sensitive and highly predictive indicator of PAS. […] Loss of the retroplacental space and myometrial thinning as predictors of PAS have high sensitivity, low specificity and a high false-positive rate. […] In our study, 7 women underwent bladder repair and 3 women underwent hysterectomy. […] This study was associated with several limitations. […] In summary, this study identified seven indicators of PAS and included them in an ultrasound scoring system for PAS that has good diagnostic efficacy and clinical utility.

• #26 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Ultrasound has reported sensitivity 90% and specificity 96% in the diagnosis of PAS. […] The above listed sonographic signs should not be used independently to diagnose PAS, as they individually may have low sensitivity and specificity for PAS. […] Studies have shown varying sensitivity rates using ultrasound for the prenatal diagnosis of PAS; these sensitivities vary, but range from 70-90%. […] The majority of published guidelines recommend the use of ultrasound for diagnosis of PAS, with magnetic resonance imaging (MRI) use as an adjunct if needed. […] The study concluded that, given the high cost and limited clinical value, MRI should not be routinely used as an adjunct to ultrasound in the detection of PAS.

• #27 Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05886-x

  To develop an ultrasound scoring system for placenta accreta spectrum (PAS), evaluate its diagnostic value, and provide a practical approach to prenatal diagnosis of PAS. […] Ultrasound is the preferred screening tool for PAS, and can reduce obstetric morbidity among at-risk women. […] Identifying women with PAS allows multidisciplinary case management in a tertiary maternity care center and decreased maternal morbidity. […] The objective of this study was to prospectively develop an ultrasound scoring system for PAS, evaluate its diagnostic value, and provide a practical approach to prenatal diagnosis of PAS. […] This study identified seven indicators of PAS and included them in an ultrasound scoring system that has good diagnostic efficacy and clinical utility. […] Using the final ultrasound scoring system, no PAS is diagnosed at a total score5, placenta accreta or placenta increta is diagnosed at a total score 510, and placenta percreta is diagnosed at a total score10.

• #28 Update on Placenta Accreta Spectrum Diagnosis and Management Chal…: Ingenta Connect

  https://www.ingentaconnect.com/content/10.2174/1573404820666230525121727

  Placenta accreta spectrum (PAS) disorders, also known as morbidly adherent placenta (MAP) include anomalous adherence of the placenta to implantation location. […] A recent study in 2020 showed that using the introduced model based on 3 parameters; uterovesical vascularity, unusual lacunae (grades 2 and 3), and bladder wall interruption, has 100% accuracy in the diagnosis of PAS. Accurate diagnosis of morbidly adherent placenta (MAP), helps in multidisciplinary team management at delivery, with better maternal and neonatal outcomes. […] Gray scale US with or without adding color Doppler and made by transabdominal or trans vaginal route are commonly utilized for prenatal screening and diagnosis of PAS. […] In a recent study made by Alalfy et al. in 2021 they revealed the systematic combined approach with the use of Alalfy Simple Criteria for assessment of placenta previa and PAS using 3D TUI (Tomographic Ultrasound Imaging and 3D power Doppler has a high diagnostic value in the diagnosis of PAS from the non-adherent placenta, the estimation of the myometrial thickness and the depth of placental invasion with the determination of different PAS subgroup plus defining diffuse from focal invasion.

• #29 Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05675-6

  To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). […] The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. […] The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. […] The accuracy of 2D ultrasound was reported in 50 studies that involved 5406 women, and 1773 of them were confirmed to have PAS through pathological examination. The overall sensitivity was 0.8703 (0.825 to 0.9051); the specificity was 0.8634 (0.8142 to 0.9012), with a -0.2348 negative correlation between them. […] The accuracy of 3D ultrasound was reported in 3 studies that involved 447 women, and 134 of them had a confirmed diagnosis of PAS. The overall estimates of sensitivity and specificity were 0.728 (0.3790.921) and 0.969 (0.7640.997), respectively. […] Our systematic review confirmed the value of ultrasound in diagnosis of PAS among women having a low lying or placenta previa with previous uterine scars. Its use is mandatory as it represents a low cost, readily available tool for prenatal diagnosis of PAS.

• #30 Placenta accreta: Diagnosis, management and the molecular biology of the morbidly adherent placenta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5424888/

  Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and intra and post-partum complications. Ultrasound is critical for diagnosis and MRI is a complementary tool when the diagnosis is uncertain. […] The prenatal diagnosis of accreta is crucial and is associated with a significant reduction in maternal blood loss and of post partum complications. Ultrasound findings suggestive of accreta include placental lacunae, myometrial thinning to less than 1 mm, the loss of a placental-uterine interface and an abnormal uterine bladder interface. The use of color and 3D Doppler ultrasound is also helpful in diagnosing placenta accreta. MRI may be helpful when the diagnosis is uncertain, if posterior invasion is concerned, or if percreta/invasion of other surrounding organs is suspected.

• #31 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  If you have risk factors for placenta accreta during pregnancy such as the placenta partially or totally covering the cervix (placenta previa) or a previous uterine surgery your health care provider will carefully examine the implantation of your baby’s placenta. […] Through an ultrasound or Magnetic resonance imaging (MRI), your health care provider can evaluate how deeply the placenta is implanted in your uterine wall. […] If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. […] In the case of extensive placenta accreta, a C-section followed by the surgical removal of the uterus (hysterectomy) might be necessary. […] During your C-section, your health care provider will deliver your baby through an initial incision in your abdomen and a second incision in your uterus.

• #32 Placenta Accreta: Types, Risks, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17846-placenta-accreta

  Placenta accreta occurs during pregnancy when the placenta attaches too deeply into the wall of your uterus. […] Pregnancy care providers diagnose placenta accreta during pregnancy or during delivery. Treatment usually involves an early Cesarean delivery (C-section) followed by a hysterectomy to minimize the risk of severe complications. […] A prenatal ultrasound can diagnose placenta accreta during pregnancy. Magnetic resonance imaging (MRI) can be helpful in some cases to show how deeply the placenta has penetrated your uterine wall. […] An early diagnosis of placenta accreta is essential because it can allow multiple healthcare providers to become involved in your pregnancy and delivery care. […] Treatment of placenta accreta can vary. If your provider diagnoses it before delivery, theyll monitor you closely for the rest of your pregnancy.

• #33 Advances in Prenatal Diagnosis of Placenta Accreta Spectrum

  https://www.mdpi.com/1648-9144/61/3/392

  Although ultrasound is frequently used for the early screening of PAS, it has limitations that may affect its diagnostic accuracy and consistency. […] In summary, ultrasound can aid in the diagnosis of PAS due to its convenience, high availability, real-time dynamic observation capabilities, and non-radiative nature, making it the primary choice for clinical screening. […] The use of MRI in diagnosing PAS has gained prominence due to its ability to provide detailed anatomical information, particularly in cases where ultrasound findings are inconclusive or limited by technical constraints. […] MRI offers superior soft tissue contrast and high-resolution imaging, making it an invaluable tool for assessing the depth of placental invasion, myometrial thinning, and the involvement of adjacent organs.

• #34 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Antenatal diagnosis of placenta accreta is typically made by ultrasound. Ultrasound reveals placenta previa. Furthermore, it is possible to visualize other abnormalities, including loss of hypoechoic division between the placenta and myometrium, increased vasculature, myometrial thinning, and extension of the placenta into serosa or bladder. Color Doppler may reveal lacunae with turbulent blood flow. Notably, the sensitivity and specificity of ultrasonography appear to be highly variable. […] Magnetic resonance imaging (MRI) has also been investigated to diagnose placenta accreta. A systemic review of the MRI-based diagnosis of placenta accreta demonstrated a specificity of 84.0% and a sensitivity of 94.4%. […] Placenta accreta spectrum is best managed when it has been diagnosed antenatally. Many steps can be undertaken to minimize risks. The American College of Obstetricians and Gynecologists (ACOG) has recommended delivery between 34 0/7 and 35 6/7 weeks of gestation via cesarean hysterectomy to optimize neonatal maturity and minimize the risk of maternal bleeding.

• #35 placenta accreta Archives – The ObG Project

  https://www.obgproject.com/tag/placenta-accreta/

  Does MRI Help or Hurt When Making a Diagnosis of Placenta Accreta? […] Ultrasound is the standard radiologic modality, while MRI remains controversial. […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B). […] The addition of MRI to the assessment of Placenta Accreta Spectrum Disorder can often lead to an incorrect diagnosis. […] The authors advise that MRI should not be used routinely as an adjunct to ultrasound in the diagnosis of Placenta Accreta Spectrum Disorder. […] The mainstay of antenatal diagnosis is ultrasound. Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A).

• #36 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  The most important risk factor implying PAS is placenta previa. This condition increases the risk of development of this anomaly and associated complications to the greatest degree. […] The presence or absence of a specific symptom mainly depends on the ultrasound operators interpretation. […] To improve the ultrasound scan sensitivity, it is recommended to perform the scan with the urinary bladder filled and additionally using the vaginal probe and the Doppler technique. […] The role of MRI in PAS diagnostics is less established. Limitations in the MRI application result from a lower availability of this method, higher costs, and fewer specialists experienced in interpreting MRI images of the placenta. […] In treating patients with suspected PAS, the appropriate preparation of the health care system, medical care centres, or clinical teams is more important than the experience and skills of an individual specialist.

• #37 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Ultrasound has reported sensitivity 90% and specificity 96% in the diagnosis of PAS. […] The above listed sonographic signs should not be used independently to diagnose PAS, as they individually may have low sensitivity and specificity for PAS. […] Studies have shown varying sensitivity rates using ultrasound for the prenatal diagnosis of PAS; these sensitivities vary, but range from 70-90%. […] The majority of published guidelines recommend the use of ultrasound for diagnosis of PAS, with magnetic resonance imaging (MRI) use as an adjunct if needed. […] The study concluded that, given the high cost and limited clinical value, MRI should not be routinely used as an adjunct to ultrasound in the detection of PAS.

• #38 placenta accreta Archives – The ObG Project

  https://www.obgproject.com/tag/placenta-accreta/

  Does MRI Help or Hurt When Making a Diagnosis of Placenta Accreta? […] Ultrasound is the standard radiologic modality, while MRI remains controversial. […] MRI has sensitivities (75%-100%) and specificities (65%-100%) approaching that of ultrasound, but has not been shown to improve the diagnostic accuracy of accreta compared to ultrasound (Grade 1B). […] The addition of MRI to the assessment of Placenta Accreta Spectrum Disorder can often lead to an incorrect diagnosis. […] The authors advise that MRI should not be used routinely as an adjunct to ultrasound in the diagnosis of Placenta Accreta Spectrum Disorder. […] The mainstay of antenatal diagnosis is ultrasound. Note: Absence of ultrasound findings does not mean the patient does not have accreta | Clinical risk factors should be weighted equally compared to sonographic findings (Grade 1A).

• #39 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  The diagnosis of placenta accreta spectrum (PAS) is difficult and sometimes uncertain. Despite years of research, PAS is still difficult to detect with ultrasound (or any other tests) in some cases. In the United States, up to 50% of patients with PAS are never diagnosed until the time of delivery. This can lead to in worse outcomes for patients who have PAS and deliver outside of a specialty center. […] Outside of busy PAS specialty centers, the diagnosis may be missed. An important thing to remember is that PAS is relatively uncommon, and many ultrasound offices will rarely see this condition. Because of this, not every ultrasound you have during pregnancy is going to be focused on finding PAS, and not every ultrasound office will have the experience to make the diagnosis or determine the severity of PAS.

• #40 National Accreta Foundation — What Do Accreta Patients Need to Know? | Placenta Accreta Patient FAQ | National Accreta Foundation

  https://www.preventaccreta.org/faq

  Placenta accreta spectrum is becoming increasingly common and is associated with significant morbidity and mortality. […] Ultrasound is the primary diagnostic tool for accreta, with most cases identified in the second and third trimesters, although it’s important to know that ultrasound is not perfect. […] Diagnosis of accreta is a critical first step in obtaining proper level care. […] The ACOG SMFM Accreta Care Consensus states: Conservative management or expectant management should be considered only for carefully selected cases of placenta accreta spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational. […] The diagnosis of placenta accreta spectrum (PAS) can be difficult and sometimes uncertain.

• #41 Prenatal Diagnosis and Outcomes of placenta accreta spectrum | IJWH

  https://www.dovepress.com/clinical-characteristics-prenatal-diagnosis-and-outcomes-of-placenta-a-peer-reviewed-fulltext-article-IJWH

  Objective: To explore the prenatal diagnosis, clinical characteristics, and perinatal outcomes of placenta accreta spectrum in different placental locations. […] The overall prenatal diagnosis rate of PAS remains relatively low. […] The prenatal diagnosis rate in the anterior placenta group was 86.4% (51/59), while the rate in the posterior placenta group was only 36.5% (19/52), the lowest among the three groups. […] The prenatal diagnosis rate and proportion of invasive form of placenta accreta spectrum occurring in non-anterior placenta are relatively lower than anterior placenta. […] The anterior placenta group had the highest rate (86.4%), while the posterior placenta group only has a rate of 36.5%. […] The absence of PP may contribute to missed diagnoses as it can lead to a relaxation of vigilance by physicians.

• #42

  https://journals.lww.com/mfm/fulltext/2021/10000/posterior_placenta_accreta_spectrum_disorders_.8.aspx

  Posterior placenta accreta spectrum (PAS) disorders are infrequent but potentially associated with significant maternal mortality and morbidity, especially if not diagnosed prenatally. […] Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies. Ultrasound has poor diagnostic accuracy in detecting posterior PAS, while magnetic resonance imaging better delineates the posterior uterine wall. […] A recent systematic review exploring prenatal imaging’s diagnostic performance in detecting posterior PAS reported a detection rate of about 52.4% with ultrasound and 73.5% with MRI, significantly lower than those reported for anterior PAS. […] The absence of the bladder interface in posterior PAS makes it challenging to assess the myometrial-placental junction, which partially explains the high rate of false-negative diagnoses in posterior placental location PAS.

• #43 First trimester diagnosis of placenta accreta spectrum resulting in spontaneous uterine rupture: A case report – Journal of Case Reports and Images in Obstetrics and Gynecology

  https://www.ijcriog.com/archive/article-full-text/100078Z08SL2021

  Placenta accreta is usually diagnosed by ultrasound. Ultrasound features that express concern for placenta accreta include an irregularly shaped lacuna in the placenta, loss of retroplacental clear space, thinning of myometrium overlying the placenta, placental protrusion into the bladder, turbulent blood flow in the lacunae on Doppler ultrasound, and increased vascularity at the serosa-bladder interface. […] Diagnosing of placenta accreta spectrum is difficult and rare in the first trimester. […] It is very uncommon to see ultrasound findings suggestive of abnormal placentation in the first trimester. […] However, a study by Rahmimi-Sharbaf et al. questions the accuracy of first trimester ultrasound findings for placenta accreta. Their study concluded that first trimester ultrasound screening does not have as high sensitivity as ultrasound screenings done in the second and third trimester.

• #44 First trimester diagnosis of placenta accreta spectrum resulting in spontaneous uterine rupture: A case report – Journal of Case Reports and Images in Obstetrics and Gynecology

  https://www.ijcriog.com/archive/article-full-text/100078Z08SL2021

  Therefore, while several case reports suggest first trimester ultrasound findings can detect placenta accreta, they appear to not have the higher sensitivity or specificity of ultrasound diagnosis in the second and third trimesters. […] Early detection is essential in the management of PAS disorders by providing patient counseling, equipping the obstetrical team with better preparedness and thereby resulting in a reduction or prevention of significant life-threatening adverse maternal and fetal outcomes. […] Our case report highlights the importance of early recognition and diagnosis of abnormal placentation or placenta accreta spectrum disorder by prenatal ultrasonography in the first and early second trimester. […] The sensitivity and specificity of diagnosis in first trimester is lower when compared to late second and third trimester ultrasonographic detection of PAS disorders.

• #45 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  The diagnosis of placenta accreta spectrum (PAS) is difficult and sometimes uncertain. Despite years of research, PAS is still difficult to detect with ultrasound (or any other tests) in some cases. In the United States, up to 50% of patients with PAS are never diagnosed until the time of delivery. This can lead to in worse outcomes for patients who have PAS and deliver outside of a specialty center. […] Outside of busy PAS specialty centers, the diagnosis may be missed. An important thing to remember is that PAS is relatively uncommon, and many ultrasound offices will rarely see this condition. Because of this, not every ultrasound you have during pregnancy is going to be focused on finding PAS, and not every ultrasound office will have the experience to make the diagnosis or determine the severity of PAS.

• #46 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Placenta accreta is defined as an abnormal invasion of all or part of the placenta into the myometrial wall of the uterus. […] The prenatal diagnosis of PAS is paramount to optimizing management and decreasing morbidity and mortality associated with the disease. […] When PAS is accurately diagnosed in the prenatal period, this provides the opportunity for a scheduled delivery at a tertiary care center, utilizing a multidisciplinary team with expertise in the management of accreta. […] The resulting evaluation of the placenta requires thorough investigation for accurate diagnoses, and the role of ultrasound in this diagnosis has been well studied and documented. […] A growing body of evidence has demonstrated that ultrasound is the preferred method of evaluation for placenta accreta spectrum disorders.

• #47 Advances in Prenatal Diagnosis of Placenta Accreta Spectrum

  https://www.mdpi.com/1648-9144/61/3/392

  Early diagnosis enables timely intervention and helps ensure that the appropriate professionals are involved in the management of this condition, ultimately improving outcomes for both mothers and neonates. […] The pathological diagnosis of PAS depends on the microscopic examination of placental villi and their attachment or invasion into the uterine myometrium. […] Therefore, early imaging with ultrasound and MRI becomes crucial, as it enables the detection of placental invasion before tissue is removed, thus guiding surgical planning and minimizing the reliance on post-surgical histopathology for critical diagnoses. […] Ultrasound is the preferred tool for the prenatal diagnosis of PAS and plays a significant role throughout various stages of pregnancy. […] Recent studies have demonstrated that PAS may exhibit specific ultrasound signs during the first trimester of pregnancy.

• #48 Placenta Accreta Spectrum (PAS) | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/obstetrics-gynecology/our-centers/columbia-mothers-center/our-services/placenta-accreta-spectrum-pas

  The diagnosis of PAS is usually suspected during a routine prenatal ultrasound. Once a patient is referred to us, a detailed ultrasound examination by a maternal-fetal medicine specialist can confirm this suspicion and assess the severity of the condition. A pelvic MRI is frequently obtained to further delineate the extent of the placental abnormality and to assist in surgical planning. It is read by a dedicated radiologist with experience in the interpretation of MRIs in patients with PAS. […] The management of PAS is complex. At NYP/CUIMC, it involves a multidisciplinary team of experts familiar with this condition. These include maternal-fetal medicine specialists, gynecologic oncologists, anesthesiologists, neonatologists, urologists, interventional radiologists, vascular surgeons, maternal mental health clinicians, and intensivists. […] A dedicated team of high-risk obstetricians will provide prenatal care, perform ultrasounds, and share their expert opinions on diagnosis and treatment options. This team also provides antenatal care, care during delivery, and postpartum care as needed.

• #49 Prepare for the unanticipated: Placenta accreta spectrum

  https://www.contemporaryobgyn.net/view/prepare-for-the-unanticipated-placenta-accreta-spectrum

  Traditional classifications were based on the layer of the uterus impacted and defined as accreta (loss of intervening decidua), increta (trophoblasts into the myometrium), and percreta (trophoblastic invasion through the serosa with possible extension to surrounding structures). […] Patients with PAS identified prior to delivery should be delivered at a center with a level of maternal care III or IV designation (or equivalent) with a comprehensive and experienced multidisciplinary team to improve outcomes. […] Delivery is typically performed at 34 0/7 to 35 6/7 weeks based on expert recommendation, but it can vary depending on patient history, prior episodes of bleeding, and staffing availability. […] Many components of the surgical management of PAS require further research. […] To reduce maternal morbidity and mortality, a streamlined process for PAS must be developed.

• #50 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Antenatal diagnosis of placenta accreta is typically made by ultrasound. Ultrasound reveals placenta previa. Furthermore, it is possible to visualize other abnormalities, including loss of hypoechoic division between the placenta and myometrium, increased vasculature, myometrial thinning, and extension of the placenta into serosa or bladder. Color Doppler may reveal lacunae with turbulent blood flow. Notably, the sensitivity and specificity of ultrasonography appear to be highly variable. […] Magnetic resonance imaging (MRI) has also been investigated to diagnose placenta accreta. A systemic review of the MRI-based diagnosis of placenta accreta demonstrated a specificity of 84.0% and a sensitivity of 94.4%. […] Placenta accreta spectrum is best managed when it has been diagnosed antenatally. Many steps can be undertaken to minimize risks. The American College of Obstetricians and Gynecologists (ACOG) has recommended delivery between 34 0/7 and 35 6/7 weeks of gestation via cesarean hysterectomy to optimize neonatal maturity and minimize the risk of maternal bleeding.

• #51 Placenta accreta: Diagnosis, management and the molecular biology of the morbidly adherent placenta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5424888/

  Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and intra and post-partum complications. Ultrasound is critical for diagnosis and MRI is a complementary tool when the diagnosis is uncertain. […] The prenatal diagnosis of accreta is crucial and is associated with a significant reduction in maternal blood loss and of post partum complications. Ultrasound findings suggestive of accreta include placental lacunae, myometrial thinning to less than 1 mm, the loss of a placental-uterine interface and an abnormal uterine bladder interface. The use of color and 3D Doppler ultrasound is also helpful in diagnosing placenta accreta. MRI may be helpful when the diagnosis is uncertain, if posterior invasion is concerned, or if percreta/invasion of other surrounding organs is suspected.

• #52 Placenta accreta – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-accreta/diagnosis-treatment/drc-20376436

  If you have risk factors for placenta accreta during pregnancy such as the placenta partially or totally covering the cervix (placenta previa) or a previous uterine surgery your health care provider will carefully examine the implantation of your baby’s placenta. […] Through an ultrasound or Magnetic resonance imaging (MRI), your health care provider can evaluate how deeply the placenta is implanted in your uterine wall. […] If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. […] In the case of extensive placenta accreta, a C-section followed by the surgical removal of the uterus (hysterectomy) might be necessary. […] During your C-section, your health care provider will deliver your baby through an initial incision in your abdomen and a second incision in your uterus.

• #53 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Close monitoring of hemodynamic status and blood loss should be performed. ACOG recommends monitoring blood loss, hemoglobin, electrolytes, blood gas, and coagulation factors to objectively determine the need for transfusion. […] The prognosis is better for patients who have placenta accreta without placenta previa. Placenta accreta with previa has a higher risk of hemorrhage and is more likely to undergo a hysterectomy, both of which contribute to morbidity. […] The most common maternal complication associated with the placenta accreta spectrum is postpartum hemorrhage. This can be associated with intraoperative hypoperfusion, transfusion, post-resuscitation fluid overload, and disseminated intravascular coagulopathy (DIC). Transfusion was required in 80% of cases, and DIC occurred in 28% of cases in one study.

• #54 Placenta Accreta: Symptoms, Risk Factors, & Treatment | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/placenta-accreta

  Placenta accreta is a pregnancy complication. It occurs when the placenta implants into scar tissue instead of healthy tissue in your uterine lining. […] We typically diagnose placenta accreta during your second-trimester ultrasound, but it can also be detected earlier in some cases. Your obstetrics provider may notice that the placenta has attached to scar tissue. In these cases, they will refer you for more ultrasounds and refer you for a consultation with one of our placenta accreta specialists. […] The standard treatment for placenta accreta is to deliver by C-section at 3436 weeks of pregnancy. Our goal is to avoid labor so you dont have heavy bleeding. […] A placenta accreta diagnosis can have significant psychological effects. People with the condition often feel worried throughout their pregnancy. Its common to experience anxiety, depression, or post-traumatic stress after your delivery.

• #55 Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel | Modern Pathology

  https://www.nature.com/articles/s41379-020-0569-1

  The pathologic diagnosis of PAS is restricted to hysterectomy or partial myometrial resection specimens, and cannot be made on placental tissue alone nor on biopsies of the placental bed. […] The diagnosis of PAS after excision is based on microscopic examination of the placental bed. […] The gross findings of PAS will depend on the type of specimen submitted, but are most apparent in a hysterectomy specimen with placenta in situ. […] The presence of an in situ placenta alone in a hysterectomy specimen is not diagnostic of PAS for pathologic reporting. […] The formulation of a microscopic definition of PAS was controversial. […] The proposed pathologic definition for PAS is for hysterectomy specimens. […] The panel felt that the evidence for the clinical importance of quantity has not been sufficiently validated. […] The grades loosely correspond to the AIP system (placenta accreta, increta, percreta), but they are descriptive rather than categorical so that they may be harmonized with, and interpreted in the context of, the FIGO grades that are driven by intraoperative findings.

• #56 Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel | Modern Pathology

  https://www.nature.com/articles/s41379-020-0569-1

  The pathologic diagnosis of PAS is restricted to hysterectomy or partial myometrial resection specimens, and cannot be made on placental tissue alone nor on biopsies of the placental bed. […] The diagnosis of PAS after excision is based on microscopic examination of the placental bed. […] The gross findings of PAS will depend on the type of specimen submitted, but are most apparent in a hysterectomy specimen with placenta in situ. […] The presence of an in situ placenta alone in a hysterectomy specimen is not diagnostic of PAS for pathologic reporting. […] The formulation of a microscopic definition of PAS was controversial. […] The proposed pathologic definition for PAS is for hysterectomy specimens. […] The panel felt that the evidence for the clinical importance of quantity has not been sufficiently validated. […] The grades loosely correspond to the AIP system (placenta accreta, increta, percreta), but they are descriptive rather than categorical so that they may be harmonized with, and interpreted in the context of, the FIGO grades that are driven by intraoperative findings.

• #57

  https://journals.lww.com/mfm/fulltext/2021/10000/confirming_the_diagnosis_and_classifying_placenta.1.aspx

  Diagnosis of placenta accreta spectrum (PAS) […] The prenatal diagnosis of PAS and in particular the differential diagnosis between abnormally adherent placenta (creta/sticky placenta/placenta retention) and abnormally invasive placenta (increta/percreta) is essential for the development of adequate management protocols and accurate epidemiology data. […] The clinical and histologic criteria for the diagnosis of accreta placentation were first reported by Irving and Hertig in 1937 and included the absence of decidual layer between the placenta and myometrium with direct attachment of the villi to the myometrium resulting in the abnormal attachment of the placenta at delivery. […] Histopathologic confirmation of diagnosis is the golden standard for PAS and perinatal pathologists should be part of multidisciplinary team involved in the management of PAS.

• #58

  https://journals.lww.com/mfm/fulltext/2021/10000/confirming_the_diagnosis_and_classifying_placenta.1.aspx

  Diagnosis of placenta accreta spectrum (PAS) […] The prenatal diagnosis of PAS and in particular the differential diagnosis between abnormally adherent placenta (creta/sticky placenta/placenta retention) and abnormally invasive placenta (increta/percreta) is essential for the development of adequate management protocols and accurate epidemiology data. […] The clinical and histologic criteria for the diagnosis of accreta placentation were first reported by Irving and Hertig in 1937 and included the absence of decidual layer between the placenta and myometrium with direct attachment of the villi to the myometrium resulting in the abnormal attachment of the placenta at delivery. […] Histopathologic confirmation of diagnosis is the golden standard for PAS and perinatal pathologists should be part of multidisciplinary team involved in the management of PAS.

• #59 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  In the management of this condition, the most crucial step is a clinical risk assessment for the occurrence of PAS related to a history of uterine surgeries, as well as a specialist ultrasound scan. […] Every medical institution that provides obstetric care should be prepared for the possibility of PAS occurrence and have a management protocol ready for such cases, as well as an option to refer patients to a referral centre.

• #60 Placenta Accreta – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563288/

  Antenatal diagnosis of placenta accreta is typically made by ultrasound. Ultrasound reveals placenta previa. Furthermore, it is possible to visualize other abnormalities, including loss of hypoechoic division between the placenta and myometrium, increased vasculature, myometrial thinning, and extension of the placenta into serosa or bladder. Color Doppler may reveal lacunae with turbulent blood flow. Notably, the sensitivity and specificity of ultrasonography appear to be highly variable. […] Magnetic resonance imaging (MRI) has also been investigated to diagnose placenta accreta. A systemic review of the MRI-based diagnosis of placenta accreta demonstrated a specificity of 84.0% and a sensitivity of 94.4%. […] Placenta accreta spectrum is best managed when it has been diagnosed antenatally. Many steps can be undertaken to minimize risks. The American College of Obstetricians and Gynecologists (ACOG) has recommended delivery between 34 0/7 and 35 6/7 weeks of gestation via cesarean hysterectomy to optimize neonatal maturity and minimize the risk of maternal bleeding.

• #61 Classification of Placenta Accreta Spectrum Disorders | Figo

  https://www.figo.org/news/classification-placenta-accreta-spectrum-disorders

  It is pivotal to improve the accuracy of placenta accreta spectrum disorders diagnosis. […] FIGOs new classification for the clinical diagnosis will improve understanding and reduce overtreatment and diagnosis-related anxiety for many patients. […] Adherence to this new FIGO classification will improve future systematic reviews and metaanalysis and provide more accurate data, which is essential to improve clinical outcomes for increasing numbers of women around the world.

• #62 Green-top Guidelines | RCOG

  https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/

  Placenta Praevia and Placenta Accreta: Diagnosis and Management (No. 27a) […] Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management (No. 27)

• #63 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  Placenta accreta spectrum (PAS) prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines […] Methods currently used to diagnose PAS are deficient and their sensitivity is insufficient. Frequently, the diagnosis is made only during labour, or intraoperatively, or ultimately following histopathological examination. Therefore, it may happen that treatment is provided at centres without the necessary infrastructure, and this will result in poorer outcomes, mainly due to an unexpected haemorrhage. […] The risk assessment for placenta accreta and a targeted ultrasound scan performed by a gynaecology and obstetrics specialist experienced in PAS diagnostics should form the basis for the diagnosis. […] Currently, studies are being conducted on PAS biomarkers, but today no clinically useful blood or urine tests are available that would enable foreseeing the development of placenta accreta.

• #64 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  In the management of this condition, the most crucial step is a clinical risk assessment for the occurrence of PAS related to a history of uterine surgeries, as well as a specialist ultrasound scan. […] Every medical institution that provides obstetric care should be prepared for the possibility of PAS occurrence and have a management protocol ready for such cases, as well as an option to refer patients to a referral centre.

• #65 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  In the management of this condition, the most crucial step is a clinical risk assessment for the occurrence of PAS related to a history of uterine surgeries, as well as a specialist ultrasound scan. […] Every medical institution that provides obstetric care should be prepared for the possibility of PAS occurrence and have a management protocol ready for such cases, as well as an option to refer patients to a referral centre.

• #66

  https://link.springer.com/article/10.1007/s40134-019-0321-0

  As the number of cesarean deliveries continues to increase, the incidence of placenta accreta spectrum (PAS) has also increased. This review focuses on the ultrasound evaluation of PAS, evaluating the accuracy of various sonographic findings and comparing these results to other imaging modalities, particularly MRI. Many updates have recently been published evaluating ultrasound and MRI as screening and diagnostic tools for diagnosing PAS. […] Additionally, we present a brief discussion of recently introduced structured reporting templates for ultrasound reporting and statistical models to predict diagnostic accuracy for PAS. […] These papers describe the benefits of standardized reporting for cases of suspected placenta accreta spectrum and demonstrate the utility of improved diagnostic abilities through standardized approaches.

• #67

  https://link.springer.com/article/10.1007/s40134-019-0321-0

  As the number of cesarean deliveries continues to increase, the incidence of placenta accreta spectrum (PAS) has also increased. This review focuses on the ultrasound evaluation of PAS, evaluating the accuracy of various sonographic findings and comparing these results to other imaging modalities, particularly MRI. Many updates have recently been published evaluating ultrasound and MRI as screening and diagnostic tools for diagnosing PAS. […] Additionally, we present a brief discussion of recently introduced structured reporting templates for ultrasound reporting and statistical models to predict diagnostic accuracy for PAS. […] These papers describe the benefits of standardized reporting for cases of suspected placenta accreta spectrum and demonstrate the utility of improved diagnostic abilities through standardized approaches.

• #68

  https://link.springer.com/article/10.1007/s40134-019-0321-0

  As the number of cesarean deliveries continues to increase, the incidence of placenta accreta spectrum (PAS) has also increased. This review focuses on the ultrasound evaluation of PAS, evaluating the accuracy of various sonographic findings and comparing these results to other imaging modalities, particularly MRI. Many updates have recently been published evaluating ultrasound and MRI as screening and diagnostic tools for diagnosing PAS. […] Additionally, we present a brief discussion of recently introduced structured reporting templates for ultrasound reporting and statistical models to predict diagnostic accuracy for PAS. […] These papers describe the benefits of standardized reporting for cases of suspected placenta accreta spectrum and demonstrate the utility of improved diagnostic abilities through standardized approaches.

• #69 Advances in Prenatal Diagnosis of Placenta Accreta Spectrum

  https://www.mdpi.com/1648-9144/61/3/392

  Early diagnosis enables timely intervention and helps ensure that the appropriate professionals are involved in the management of this condition, ultimately improving outcomes for both mothers and neonates. […] The pathological diagnosis of PAS depends on the microscopic examination of placental villi and their attachment or invasion into the uterine myometrium. […] Therefore, early imaging with ultrasound and MRI becomes crucial, as it enables the detection of placental invasion before tissue is removed, thus guiding surgical planning and minimizing the reliance on post-surgical histopathology for critical diagnoses. […] Ultrasound is the preferred tool for the prenatal diagnosis of PAS and plays a significant role throughout various stages of pregnancy. […] Recent studies have demonstrated that PAS may exhibit specific ultrasound signs during the first trimester of pregnancy.

• #70 Placenta accreta scoring system (PASS)—assessment of a simplified clinico-radiological scoring system for antenatal diagnosis of placenta accreta | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-021-00427-y

  To address this issue, we have attempted in this study to develop a scoring system based on clinical and MRI features and to assess its accuracy in predicting PA. […] A score of greater than or equal to 6 provided sensitivity, specificity and accuracy of 85.71, 94.87 and 92.5% respectively in diagnosing placenta accreta. […] MRI is an important tool in assessing placenta accreta spectrum of disorders, and PASS provides an accurate and objective way to stratify patients into low-, intermediate- and high-risk categories for PA.

• #71 Ultrasound, MRI Aid Placenta Accreta Diagnosis | Imaging Technology News

  https://www.itnonline.com/content/ultrasound-mri-aid-placenta-accreta-diagnosis

  Placental bulge sign on prenatal ultrasound or MRI helps diagnose severe placental accreta spectrum disorder warranting hysterectomy rather than conservative management […] According to an open-access Editor’s Choice article in ARRS’ American Journal of Roentgenology (AJR), accurate prenatal diagnosis of severe placental accreta spectrum (PAS) disorder by imaging could help guide maternal counseling and selection between hysterectomy and uterine-preserving surgery. […] „In diagnosing severe PAS,” Dighe et al. noted, „placental bulge sign achieved on ultrasound an accuracy of 85.5%, sensitivity of 91.7%, and specificity of 76.9%, and on MRI an accuracy of 90.3%, sensitivity of 94.4%, and specificity of 84.6%.” Ultimately, placental bulge was an independent predictor of severe PAS on ultrasound (odds ratio=8.94) and MRI (odds ratio=45.67). […] „Placental bulge sign on either prenatal ultrasound or MRI may help diagnose severe PAS warranting hysterectomy rather than conservative management,” the authors of this AJR article concluded.

• #72 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  Placenta accreta spectrum (PAS) prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines […] Methods currently used to diagnose PAS are deficient and their sensitivity is insufficient. Frequently, the diagnosis is made only during labour, or intraoperatively, or ultimately following histopathological examination. Therefore, it may happen that treatment is provided at centres without the necessary infrastructure, and this will result in poorer outcomes, mainly due to an unexpected haemorrhage. […] The risk assessment for placenta accreta and a targeted ultrasound scan performed by a gynaecology and obstetrics specialist experienced in PAS diagnostics should form the basis for the diagnosis. […] Currently, studies are being conducted on PAS biomarkers, but today no clinically useful blood or urine tests are available that would enable foreseeing the development of placenta accreta.

• #73 Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines | Huras | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/101422

  Placenta accreta spectrum (PAS) prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines […] Methods currently used to diagnose PAS are deficient and their sensitivity is insufficient. Frequently, the diagnosis is made only during labour, or intraoperatively, or ultimately following histopathological examination. Therefore, it may happen that treatment is provided at centres without the necessary infrastructure, and this will result in poorer outcomes, mainly due to an unexpected haemorrhage. […] The risk assessment for placenta accreta and a targeted ultrasound scan performed by a gynaecology and obstetrics specialist experienced in PAS diagnostics should form the basis for the diagnosis. […] Currently, studies are being conducted on PAS biomarkers, but today no clinically useful blood or urine tests are available that would enable foreseeing the development of placenta accreta.

• #74 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  The diagnosis of placenta accreta spectrum (PAS) is difficult and sometimes uncertain. Despite years of research, PAS is still difficult to detect with ultrasound (or any other tests) in some cases. In the United States, up to 50% of patients with PAS are never diagnosed until the time of delivery. This can lead to in worse outcomes for patients who have PAS and deliver outside of a specialty center. […] Outside of busy PAS specialty centers, the diagnosis may be missed. An important thing to remember is that PAS is relatively uncommon, and many ultrasound offices will rarely see this condition. Because of this, not every ultrasound you have during pregnancy is going to be focused on finding PAS, and not every ultrasound office will have the experience to make the diagnosis or determine the severity of PAS.

• #75 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  Experience with PAS matters. Even great doctors and busy OB practices who can manage most pregnancy complications may not be sufficiently prepared for PAS. Patients who deliver at busy PAS specialty centers have safer deliveries than patients who deliver at hospitals where the doctors don’t see PAS very often. […] The team matters more than the individual doctor or provider. The best PAS centers have dedicated teams of numerous doctors, nurses, and support staff devoted to caring for patients with PAS. The experience of the team is more important to patient safety than the individual experience of the doctor or surgeon. […] Planning is important. Safely preparing for PAS surgery takes a lot of time and discussion between teams (surgery, delivery, anesthesia, NICU, blood bank, and other services).

• #76 Coding for Placenta Accreta Spectrum – Society for Maternal-Fetal Medicine

  https://www.smfm.org/news/coding-for-placenta-accreta-spectrum

  Placenta accreta is defined as an abnormal invasion of all or part of the placenta into the myometrial wall of the uterus. […] The prenatal diagnosis of PAS is paramount to optimizing management and decreasing morbidity and mortality associated with the disease. […] When PAS is accurately diagnosed in the prenatal period, this provides the opportunity for a scheduled delivery at a tertiary care center, utilizing a multidisciplinary team with expertise in the management of accreta. […] The resulting evaluation of the placenta requires thorough investigation for accurate diagnoses, and the role of ultrasound in this diagnosis has been well studied and documented. […] A growing body of evidence has demonstrated that ultrasound is the preferred method of evaluation for placenta accreta spectrum disorders.

• #77 Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging

  https://www.mdpi.com/2075-4418/12/11/2769

  Placenta accreta spectrum (PAS) disorder comprehends a group of anomalies characterized by an abnormal adhesion or invasion of the trophoblastic tissue to the uterine myometrium and serosa. The spectrum encompasses placenta accreta (attachment of the placenta to the myometrium without interposed decidua), placenta increta (invasion through the myometrium), and placenta percreta (invasion through serosa and eventually other adjacent structures). PAS is one of the most dangerous conditions associated with pregnancy because it can cause massive hemorrhage leading to multisystem organ failure, disseminated intravascular coagulation, the necessity for an intensive care unit, hysterectomy, and even death. It represents the first cause for both a hysterectomy associated with a caesarean section and a peripartum hysterectomy. Diagnostic difficulties are still high and PAS remains undiagnosed in between half and two-thirds of cases. The necessity for pre-surgery planning in case of PAS enhances the importance of accurate prenatal diagnosis, which is essential to reduce the burden of maternal and fetal morbidity associated with this pathology. Currently, diagnosis is primarily based on ultrasound (US), which has proved to be very reliable when performed by experienced operators. US findings suggesting PAS disorders described by grey-scale ultrasound imaging are the loss of the hypoechoic retroplacental (clear) zone because of the abnormal extensions of placental villi into decidua, abnormal placental lacunae, myometrial thinning, hyperechoic uterus–bladder interface, exophytic mass, and placental bulge. The purpose of our study is to evaluate the diagnostic accuracy of US and MRI in the diagnosis of PAS and to define the most relevant characteristics that can predict placental invasion. The study was conducted according to the guidelines of the Declaration of Helsinki. In our study, according to the literature, US shows a good performance in identifying the presence of PAS both in anterior and posterior placenta with an accuracy of 94% vs. 67%. Therefore, the use of a US-standardized score offers good results in PAS/no-PAS diagnosis considering all the parameters analyzed. In conclusion, US performed by experienced operators is a diagnostic tool for PAS. However, large prospective studies are necessary to confirm these results and to develop standardized protocols to improve the outcomes of women affected by PAS disorders.

• #78 First trimester diagnosis of placenta accreta spectrum resulting in spontaneous uterine rupture: A case report – Journal of Case Reports and Images in Obstetrics and Gynecology

  https://www.ijcriog.com/archive/article-full-text/100078Z08SL2021

  Therefore, while several case reports suggest first trimester ultrasound findings can detect placenta accreta, they appear to not have the higher sensitivity or specificity of ultrasound diagnosis in the second and third trimesters. […] Early detection is essential in the management of PAS disorders by providing patient counseling, equipping the obstetrical team with better preparedness and thereby resulting in a reduction or prevention of significant life-threatening adverse maternal and fetal outcomes. […] Our case report highlights the importance of early recognition and diagnosis of abnormal placentation or placenta accreta spectrum disorder by prenatal ultrasonography in the first and early second trimester. […] The sensitivity and specificity of diagnosis in first trimester is lower when compared to late second and third trimester ultrasonographic detection of PAS disorders.

• #79 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  Experience with PAS matters. Even great doctors and busy OB practices who can manage most pregnancy complications may not be sufficiently prepared for PAS. Patients who deliver at busy PAS specialty centers have safer deliveries than patients who deliver at hospitals where the doctors don’t see PAS very often. […] The team matters more than the individual doctor or provider. The best PAS centers have dedicated teams of numerous doctors, nurses, and support staff devoted to caring for patients with PAS. The experience of the team is more important to patient safety than the individual experience of the doctor or surgeon. […] Planning is important. Safely preparing for PAS surgery takes a lot of time and discussion between teams (surgery, delivery, anesthesia, NICU, blood bank, and other services).

• #80 National Accreta Foundation — Seeking a Second Opinion in PAS Care

  https://www.preventaccreta.org/second-opinion

  For PAS care, second opinions are particularly important because this is such a difficult diagnosis to make, and the answers are not always clear. […] The best PAS centers have organized and transparent. At the current time, there is no formal accreditation process for PAS specialty centers, so it can be difficult for patients (and referring providers) to know where to seek a second opinion or expert care. […] Even with a sure diagnosis, PAS is unpredictable. No prenatal imaging or blood work can predict exactly how or when you will deliver or how difficult your delivery and surgery will be. Serious complications can occur even when the doctors think your case might be mild. […] Being prepared for the worst in every case is a hallmark of excellent PAS care. Whether your case is mild or severe, we advise people to have their PAS delivery and surgery at an experienced PAS specialty center.

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