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. […] The incidence of placenta accreta has increased from 1 in 30,000 pregnancies in the 1960s to 1 in 533 pregnancies in the 2000s. One study quotes the current incidence as high as 1 in 272. As previously noted, prior cesarean delivery is a risk factor for placenta accreta, so the rise in placenta accreta incidence over the past decades reflects the rise in cesarean deliveries. Furthermore, it has been established that an increased number of prior cesarean sections increases the risk of placenta accreta. Approximately 6.7% of patients with 5 prior c-sections were noted to have placenta accreta, compared to 0.3% of patients with 1 prior c-section.

• #2 Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3356715/

  Placenta accreta is becoming an increasingly common complication of pregnancy, likely related to the increasing rate of cesarean delivery over the last five decades. Placenta accreta occurs in approximately 1:1000 deliveries with a reported range from 0.04% rising up to 0.9%. […] The risk of developing placenta accreta increases with the number of previous cesarean deliveries. These range from 2% among women with a placenta previa only to 3960% among women with accompanied two or more prior cesarean deliveries. Up to 88% of the women have concomitant placenta previa. […] Once a rare occurrence, placenta accreta is becoming an increasingly common complication of pregnancy, mainly due to the increasing rate of cesarean delivery over the past 50 years. In view of the fact that the indications for cesarean delivery seem to be steadily expanding, including cesarean delivery on maternal request, the incidence of placenta accreta is likely to continue to increase.

• #2 PAS diagnosis challenges and controversies in obstetrics | IJWH

  https://www.dovepress.com/placenta-accreta-spectrum-diagnosis-challenges-and-controversies-in-cu-peer-reviewed-fulltext-article-IJWH

  The incidence of PAS increased from 1 in 2510 women before 1994 to 1 in 533 women in 2002, and it counted as 4 in 1000 women in 2003 and 1 in 272 women in 2016. […] The main reason may be that the lower segment of the uterus is relatively weak, and cesarean section can cause local endometrial loss or damage, resulting in local decidual dysplasia or no formation of the decidua. […] The diagnosis of PAS lacks specific manifestations and characteristic serological indicators. […] Therefore, prenatal diagnosis is difficult, and imaging examinations are often needed. […] The antenatal diagnosis of PAS by ultrasound (transvaginal, transabdominal, and color Doppler) is made during the second trimester of pregnancy when assessing the fetal anatomy and it may be revised again at 32 weeks of gestation.

• #3 PAS diagnosis challenges and controversies in obstetrics | IJWH

  https://www.dovepress.com/placenta-accreta-spectrum-diagnosis-challenges-and-controversies-in-cu-peer-reviewed-fulltext-article-IJWH

  The incidence of PAS increased from 1 in 2510 women before 1994 to 1 in 533 women in 2002, and it counted as 4 in 1000 women in 2003 and 1 in 272 women in 2016. […] The main reason may be that the lower segment of the uterus is relatively weak, and cesarean section can cause local endometrial loss or damage, resulting in local decidual dysplasia or no formation of the decidua. […] The diagnosis of PAS lacks specific manifestations and characteristic serological indicators. […] Therefore, prenatal diagnosis is difficult, and imaging examinations are often needed. […] The antenatal diagnosis of PAS by ultrasound (transvaginal, transabdominal, and color Doppler) is made during the second trimester of pregnancy when assessing the fetal anatomy and it may be revised again at 32 weeks of gestation.

• #4 Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252654

  Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. […] The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. […] A cohort of 384 women with PAS was identified from a source population of 458,995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75-0.92). […] The analysis of maternal characteristics showed a substantially higher risk of PAS in women with placenta previa or low-lying and with previous CS or other uterine surgery, with the greatest risk increase for 2 previous CS (RR 17.6; 95% CI, 12.9-24.0). […] Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.

• #5 Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2466-5

  Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. […] The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). […] The incidence of PAS disorders was 0.91%. Maternal age 32 years, previous C.S. (2), multiparity (3) and previous history of placenta previa were risk factors. […] The incidence of PAS disorders in the present study was 9 / 1000 maternities overall (0.91%), this incidence is comparable with published studies in the last decade (0.40-0.9%). […] The present results revealed that risk factors for PAS disorders were maternal age, 32 years, previous cesarean sections (2), multiparity (3) and previous history of placenta previa. […] The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy.

• #6 Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052893

  Placenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors. […] The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall; 577 per 10,000 in women with both a previous caesarean delivery and placenta praevia. […] Women with both a prior caesarean delivery and placenta praevia have a high incidence of placenta accreta/increta/percreta. […] The risk associated with these factors has not been quantified on a population basis in studies using robust clinical and pathological definitions. […] This study demonstrates the rarity of placenta accreta/increta/percreta using a robust clinical and pathological definition, estimating the incidence in the UK to be 1.7 per 10,000 maternities overall. However, the incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around one in every twenty such women.

• #7

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

  Before 2018, there were various terms used to describe PAS disorders, such as morbidly adherent placenta (US/Egypt/Israel), adhesive placenta (Italy/Argentina), and pernicious placenta (Chinese mainland). […] 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. […] A systematic review and meta-analysis including 29 studies and 7001 cases of PAS found that the prevalence of PAS was highly variable, ranging between 0.01% and 1.1% with an overall pooled prevalence of 0.17% (95% confidence interval, 0.140.19). […] This considerable heterogeneity in prevalence and incidence of PAS highlights methodologic inconsistencies between studies with regards to clinical criteria that were used for the diagnosis of both placenta previa and PAS and the histopathologic confirmation of the diagnosis and differential diagnosis between adherent and invasive accreta placentation.

• #8 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  The general resources needed to be able to attain improved health outcomes in the setting of a known or suspected placenta accreta include planning for delivery with appropriate subspecialists and having access to a blood bank with protocols in place for massive transfusion. […] Rates of placenta accreta spectrum are increasing. […] The increasing rate of placenta accreta over the past four decades is likely due to a change in risk factors, most notably the increased rate of cesarean delivery. […] There are several risk factors for placenta accreta spectrum. […] Placenta accreta spectrum occurs in 3% of women diagnosed with placenta previa and no prior cesarean deliveries. […] Maternal serum alpha fetoprotein is a poor predictor of placenta accreta spectrum and is not accurate enough to be clinically useful.

• #9 Placenta Accreta Spectrum – FMF Courses

  https://courses.fetalmedicine.com/fmf/show/1040?locale=en

  In the 1930s the prevalence of placenta accreta spectrum (PAS) disorders was about 1 in 30,000 births but now the rate has increased to 1 in 800-1000 births. […] The main risk factor for PAS is previous cesarean section delivery and placenta previa in the current pregnancy. […] In the presence of placenta previa the risk of PAS increases from 3% in those without a previous cesarean section to about 10%, 40% and 60% after 1, 2 and 3 previous cesarean sections, respectively. […] The main adverse effect of cesarean delivery is failure of adequate healing of the myometrium leaving a gap. The scar tissue is poorly vascularized, less elastic and prone to rupture during labor in subsequent pregnancies and the risk increases with increasing number of cesarean sections.

• #10 Placenta accreta spectrum – Wikipedia

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

  The reported incidence of placenta accreta has increased from approximately 0.8 per 1000 deliveries in the 1980s to 3 per 1000 deliveries in the past decade. […] Incidence has been increasing with increased rates of cesarean deliveries, with rates of 1 in 4,027 pregnancies in the 1970s, 1 in 2,510 in the 1980s, and 1 in 533 for 1982-2002. […] In 2002, ACOG estimated that incidence has increased 10-fold over the past 50 years. […] The risk of placenta accreta in future deliveries after cesarean section is 0.4-0.8%. […] For patients with placenta previa, risk increases with number of previous cesarean sections, with rates of 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater number of cesarean sections. […] It is extremely important for pregnant mothers to be aware of this condition, its risk factors, treatment and management, to ensure their health and the health of their baby, and prevent complications throughout the pregnancy.

• #11 Placenta accreta | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/placenta-accreta?lang=us

  It is the most common form of placental invasion (~75% of cases). It is thought to occur in approximately 1 in 7000 pregnancies. The incidence is increasing due to the increased practice of cesarean sections. The combination of a previous cesarean section and an anterior placenta previa should raise the possibility of a placenta accreta. This disease has maternal mortality of up to 7% depending on location. […] Recognized primary risk factors for placenta accreta include: placenta previa, prior cesarean section, uterine anomalies, previous uterine surgery, dilation and curettage, myomectomy, maternal age 35 years, and multiparity.

• #12 Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052893

  The risk of placenta accreta/increta/percreta appears to be raised in women who have a previous caesarean delivery, other previous uterine surgery, an IVF pregnancy and placenta praevia diagnosed antepartum. There was also an increased risk of placenta accreta/increta/percreta associated with older maternal age in women without a previous caesarean delivery.

• #13 Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study | Scientific Reports

  https://www.nature.com/articles/s41598-024-56964-9

  This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. […] The factors independently associated with PAS disorders were BMI30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. […] Overall, 30 to 65% of PAS cases occur in women with at least one prior cesarean and a placenta previa or low-lying. […] The combination of these two factors has been identified as a profile at high risk for PAS, and prenatal screening for these disorders is usually performed among this subgroup of women, rather than among all pregnant women. […] We found that the risk of PAS increases not only with the number of prior cesareans but also varies with the placenta location relative to the internal cervical os: despite findings about the risk of PAS and the number of previous cesareans, no study had explored the risk according to the placenta location.

• #14 Epidemiology and Risk Factors of Placenta Accreta Spectrum in Pregnancies with Assisted Reproductive Technology: A Retrospective Study in Southwest of Iran

  https://www.jogcr.com/article_718841.html

  Placenta accreta is a serious condition associated with abnormal placental attachment, leading to significant maternal and fetal complications. […] This study was performed with aim to explore the relationship between assisted reproductive technology (ART) related pregnancy and the incidence of placenta accreta, as well as to identify demographic characteristics and potential risk factors associated with this condition. […] The rate of placenta accreta was significantly higher in IVF pregnancies (P=0.047). […] The findings of the present study demonstrated that IVF pregnancies have a higher incidence of placenta accreta. Furthermore, advanced maternal age, higher number of gestations, history of abortion, presence of placenta previa, and previous cesarean deliveries were associated with placenta accreta.

• #15 Placenta Accreta | UKOSS | NPEU

  https://www.npeu.ox.ac.uk/ukoss/completed-surveillance/pa

  Placenta accreta is thought to be becoming more common due to a number of factors including rising maternal age at delivery and an increasing proportion of deliveries by caesarean section. […] This study will describe the current management of placenta accreta in the UK and associated outcomes for women and their infants. In addition, this study will estimate the national incidence of placenta accreta in the UK and identify the extent to which previous caesarean section and older maternal age are risk factors in this population. […] To use the UK Obstetric Surveillance System to describe the epidemiology of placenta accreta/percreta/increta in the UK. […] What is the current incidence of placenta accreta/increta/percreta in the UK? […] The presence of placenta accreta/increta/percreta is associated with major pregnancy complications, including life-threatening maternal haemorrhage, uterine rupture, peripartum hysterectomy and maternal death, as well as complications associated with surgical removal including damage to bladder, ureters and other organs.

• #16 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  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 primary diagnostic modality for antenatal diagnosis is obstetric ultrasonography. […] 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. […] The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. […] Delivery in highly experienced maternity centers that have this type of coordinated care team and the ability to garner additional expertise and resources in cases of severe hemorrhage appears to improve outcomes.

• #17 Placenta Accreta Spectrum | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum

  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. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. […] Rates of maternal death are increased for women with placenta accreta spectrum. […] In 2015, the American College of Obstetricians and Gynecologists (ACOG) and the Society for MaternalFetal Medicine developed a standardized risk-appropriate maternal idealized care system for facilities, based on region and expertise of the medical staff, to reduce overall maternal morbidity and mortality in the United States. […] Placenta accreta spectrum is considered a high-risk condition with serious associated morbidities; therefore, ACOG and the Society for MaternalFetal Medicine recommend these patients receive level III (subspecialty) or higher care.

• #18 Placenta Accreta Spectrum Program | Riley Children’s Health

  https://www.rileychildrens.org/departments/placenta-accreta-spectrum-program

  The Placenta Accreta Spectrum Program at Riley Children’s Health and Indiana University Health offers specialized care for pregnancies complicated by abnormal placental growth into or beyond the uterine wall. This condition, known as the placenta accreta spectrum (PAS), includes placenta accreta, increta, and percreta, and poses significant risk of life-threatening hemorrhage during childbirth. […] Several factors increase the risk of developing PAS, including: Cesarean delivery, Placenta previa, Dilation and curettage (D&C), Myomectomy, Asherman syndrome, In Vitro Fertilization (IVF). […] An ultrasound is the primary tool for diagnosing PAS, and it is often performed during the second or third trimester of pregnancy. Magnetic Resonance Imaging (MRI) is also used to provide additional detail and confirm the extent of placental invasion. […] Our Placenta Accreta Spectrum Program is part of the Pan American Society for the Placenta Accreta Spectrum (PAS-squared), in which we collaborate clinically and on a research level to improve care and outcomes.

• #19 PAS diagnosis challenges and controversies in obstetrics | IJWH

  https://www.dovepress.com/placenta-accreta-spectrum-diagnosis-challenges-and-controversies-in-cu-peer-reviewed-fulltext-article-IJWH

  The serological examination is also feasible when necessary, but its specificity is relatively low. […] The diagnosis of PAS requires the availability of multidisciplinary team care with well-experienced radiologists in ultrasound and MRI, histopathologists, obstetricians, nursing staff experts, blood bank, and laboratory specialists to establish the accurate diagnosis and management of PAS.

• #20 SciELO Brazil – Placenta Accreta Spectrum Disorders: Current Recommendations from the Perspective of Antenatal Imaging Placenta Accreta Spectrum Disorders: Current Recommendations from the Perspective of Antenatal Imaging

  https://www.scielo.br/j/rbgo/a/3S69Z4Ch5txkx4fHChNz9xQ/?lang=en

  For screening purposes, all sonographers responsible for obstetrical ultrasounds should always ask themselves two questions: (1) is the placenta low-lying? (2) did the patient have a previous uterine surgery? […] Screening for CSP should ideally be performed for all patients with previous CS between 6-9 gestational weeks, when the gestational sac is more related to the uterine scar niche than to the uterine cavity, resulting in better accuracy. […] Diagnostic accuracy for CSP/PAS in specialized diagnostic centers, mainly using ultrasound but relying on nuclear magnetic resonance for specific cases, is usually higher than 90%. […] Antenatal diagnosis of PAS is not easy and most obstetricians do not receive comprehensive training during their residence to diagnose or treat this disease. […] To conclude, qualified ultrasound screening for CSP/PAS should be widely available, focusing on risk factors and placental position on ultrasound.

• #21 Incidence, risk factors and maternal outcomes of unsuspected placenta accreta spectrum disorders: a retrospective cohort study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06254-z

  To identify incidence and underlying risk factors for unsuspected placenta accreta spectrum (PAS) and compare the maternal outcomes between suspected and unsuspected cases in three large academic referral centers. […] The incidence of PAS has increased dramatically in recent years due to the rise in global cesarean delivery rates, particularly in countries like China where the rate has exceeded 50%. […] Our findings indicate that 35% of patients with PAS were unsuspected prior to delivery. Factors associated with PAS being unsuspected prior to delivery include a history of intrauterine adhesions, a history of clinically confirmed PAS, a posterior placenta, and a history of placenta previa. […] The finding that 35.4% of cases of placenta accreta spectrum (PAS) were not suspected before delivery over a 10-year period emphasizes the necessity for further improvement in PAS diagnosis.

• #22 SciELO Brazil – Placenta Accreta Spectrum Disorders: Current Recommendations from the Perspective of Antenatal Imaging Placenta Accreta Spectrum Disorders: Current Recommendations from the Perspective of Antenatal Imaging

  https://www.scielo.br/j/rbgo/a/3S69Z4Ch5txkx4fHChNz9xQ/?lang=en

  Pregnant women with previous uterine scars are at risk for increased morbimortality. […] A previous CS increases up to 60% the risk for placenta previa at delivery (approximate incidence: 0.3-2%), with a dose-response pattern based on the number of previous surgeries. […] More than 90% of PAS cases occurred in women with a previous CS and low-lying/placenta previa. […] A retrospective Latin American study reported that among 52 maternal deaths related to PAS, 40% did not have antenatal diagnosis and almost 46% were not evaluated in a PAS referral hospital before delivery. […] Therefore, regional PAS care pathways should be set up to ensure every pregnant women has access to qualified primary care ultrasound and, in case of a positive screening for CSP/PAS, prompt referral for a specialized diagnostic center should be made.

• #23 Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252654

  This study showed that prevalence of PAS in the participating Italian regions was 0.84, with higher rates in Southern Italy. […] Almost half of our patients had a high-risk clinical profile. […] Management in specialized centers should be considered for all high-risk cases as pivotal determinant in improving outcomes.

• #24 Placenta Accreta Spectrum (PAS) Outside of the Centers for Excellence-Avoiding Clinical Catastrophes | Long School of Medicine

  https://uthscsa.edu/medicine/education/cme/courses/placenta-accreta-spectrum

  The incidence of PAS and SMM continue to rise in our region and surrounding areas. […] Research has shown that rural communities continue to experience greater maternal morbidity at a rate higher than what is seen in urban areas. […] Review Epidemiology and Pathophysiology leading to P.A.S. incidence.

• #25 Classification of Placenta Accreta Spectrum Disorders | Figo

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

  There is now compelling evidence that placenta accreta spectrum disorders are related to medical intervention: specifically the caesarean section epidemic. More than 90 percent of women presenting with a placenta accreta have had at least one prior cesarean delivery, and with the continuous rise in cesarean delivery rates in most countries around the world, both the prevalence and incidence of placenta accreta spectrum disorders will continue to increase.

• #26 Placenta Accreta Spectrum; Risk Factors, Complications, Advantages and Disadvantages to Decrease Maternal Morbidity and Mortality

  https://www.jogcr.com/article_709300.html

  Placenta Accreta Spectrum (PAS) is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean delivery, which is increasing without medical indication. […] The risk of placenta accreta spectrum (PAS) is significantly higher in cases where there has been a previous cesarean delivery and placenta previa (p0.05). […] Women with previous cesarean delivery are significantly at risk of placenta accreta in their future pregnancies. Pregnant women should avoid insisting on elective cesarean delivery without medical indication. Planned cesarean delivery could reduce the maternal complications. […] The incidence of placenta accreta spectrum (PAS) varies from 1.7 to 14.1 per 10000 deliveries depending on regions. Raised cesarean deliveries (CDs) rate led to an increased prevalence of PAS during recent years. The majority of studies revealed that women with a history of CD are at increased risk of placenta accreta.

• #27 Surveillance of placenta accreta | NPEU

  https://www.npeu.ox.ac.uk/research/projects/72-ukoss-placenta-accreta

  Placenta accreta refers to a group of uterine diseases which are characterised by an abnormally adherent placenta. […] The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall; 577 per 10,000 in women with both a previous caesarean delivery and placenta praevia. […] This study shows that women with both a prior caesarean delivery and placenta praevia have a high incidence of placenta accreta/increta/percreta. There is a need to maintain a high index of suspicion of abnormal placental invasion in such women and preparations for delivery should be made accordingly. […] These findings support current RCOG and other guidelines which recommend that if the placenta fails to separate, no attempt is made to remove it prior to a planned attempt at uterine conservation or hysterectomy.

• #28 Epidemiology of placenta previa accreta: a systematic review and meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/9/11/e031193.abstract

  Objective To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis. […] The meta-analysis indicated a significant (p0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. […] The high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness.

• #29

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

  Many clinicians and the World Health Organization international classification of diseases continue to use the 1937 Irving and Hertig definition for placenta accreta and therefore make no distinction between different grades of PAS. […] Only 10% of studies on the prenatal diagnosis of PAS and placenta previa accreta provide detailed histopathology data on the different grades of PAS, and the corresponding distribution varies widely. […] This new FIGO classification, together with the standardized prenatal imaging descriptions and proforma reporting for suspected antenatally with placenta accreta, have been established with the intent of improving the overall quality of epidemiologic data on PAS incidence.

• #30 Placenta Accreta Spectrum Disorders: A Critical Absence from the Cesarean Section Debate – Maternal Health Task Force

  https://www.mhtf.org/2018/05/08/placenta-accreta-spectrum-disorders-a-critical-absence-from-the-c-section-debate/

  A critical absence from the recent c-section debate has been the long-term health impact of excessively high c-section rates, in particular in populations with high fertility rates, such as Egypt (c-section rate 53% and fertility rate 37/1000 women) and Mexico (45% and 33/1000 women, respectively). […] The rising rates of c-section are directly linked to the rising prevalence and incidence of placenta accreta spectrum disorder. […] In March 2018, the International Journal of Gynecology and Obstetrics (FIGO) published a special issue on placenta accreta spectrum disorders, including the new FIGO consensus guidelines on the epidemiology, prenatal diagnosis and surgical and conservative management of this condition, alongside a series of peer-reviewed original articles on placenta accreta spectrum that provide a comprehensive overview of this complex disorder.

• #31 Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study | Scientific Reports

  https://www.nature.com/articles/s41598-024-56964-9

  The specific identification of risk factors for PAS in women with any prior cesareans and an abnormally located placenta may be useful for pinpointing women at particularly high risk of PAS to customize the information they receive as well as their care during pregnancy and delivery. […] Finally, the rate of PAS disorders varies greatly not only with the number of prior cesareans but also with the precise location of the placenta and some of the women’s individual characteristics.

• #32 Top Published Expert Doctors for Placenta Accreta

  https://findexpertmd.com/d/Placenta_Accreta

  582 top medical experts on Placenta Accreta across 45 countries and 30 U.S. states, including 496 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials: at least 75 including 28 Completed, 16 Recruiting.

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