Materiały źródłowe

• #1 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. […] 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. […] 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.

• #2 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The placenta accreta spectrum (PAS) is defined as a morbidly adherent placenta and includes placenta increta, accreta, and percreta. In recent years, the prevalence of PAS has increased and is currently estimated to be 1 out of 500 births. Despite advances in prenatal ultrasound and diagnosis and referral to experienced surgical centers, abnormal placentation remains one of the main causes for postpartum hemorrhage (PPH), increased maternal morbidity and mortality. Median blood loss during delivery in women diagnosed with PAS is estimated to be 3000 mL. In addition, >90.0% of all women with PAS receive red blood cell (RBC) transfusion during childbirth. Planned caesarean hysterectomy (HE) at the time of the delivery is the standard of care. Uterine artery embolization (UAE) is an alternative to caesarean HE, allowing preservation of the uterus and improvement of PPH, recommended by several national and international guidelines.

• #3 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. […] A recently published study based on accreta deliveries between 1998-2011 found that while accreta was associated with as much as a 19-fold increase in adverse outcomes (including hysterectomy, transfusion and prolonged hospital stay), there were very few maternal deaths in their sample. […] It is important to note that in general, accreta moms keep their ovaries and do not go into menopause from an accreta related hysterectomy. […] 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. […] Accreta literature has previously indicated that better outcomes are achieved at a placenta accreta center of excellence, or at facilities with experience and expertise in treating accreta.

• #4 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #5 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. […] 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. […] 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.

• #6 Placenta Accreta Spectrum | ACOG

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

  The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. […] Taking these limited published data together, and the accepted approach of hysterectomy to treat placenta accreta spectrum, 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.

• #7 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

  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. […] In conclusion, our data revealed that approximately one-third of PAS cases were not suspected during antenatal screening, and these unsuspected cases exhibited poorer outcomes compared to the suspected cases. Risk factors for lack of suspicion include a history of intrauterine adhesions, clinically confirmed PAS, posterior placenta, and placenta previa. Increasing awareness of these risk factors could facilitate early diagnosis of PAS and enhance maternal outcomes.

• #8 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

  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. […] In conclusion, our data revealed that approximately one-third of PAS cases were not suspected during antenatal screening, and these unsuspected cases exhibited poorer outcomes compared to the suspected cases. Risk factors for lack of suspicion include a history of intrauterine adhesions, clinically confirmed PAS, posterior placenta, and placenta previa. Increasing awareness of these risk factors could facilitate early diagnosis of PAS and enhance maternal outcomes.

• #9 Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7653210/

  Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. […] However, since diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively. […] In conclusion, in our cohort, diagnosis of placenta accreta was first made intraoperatively in nearly a third of cesarean hysterectomies. While most patients undergoing cesarean hysterectomy for clinically diagnosed placenta accreta had the diagnosis confirmed on pathologic examination, there was a 4% false positive rate. […] These findings re-enforce the need for vigilance intraoperatively as the need for cesarean hysterectomy may not be anticipated preoperatively.

• #10 An ultrasonic scoring system to predict the prognosis of placenta accreta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6392640/

  To discuss the value of self-made ultrasonic scoring system in predicting the different types of placenta accreta, and for predicting its associated risk of bleeding and hysterectomy. […] These results suggested that self-made ultrasonic scoring system remained an effective diagnostic tool for assessing the types of placenta accreta, and predicted the associated bleeding risk, indicating the possibility of hysterectomy. […] The study indicated that the accuracy of the scoring system for predicting the pathologic types of placenta accreta as 83.9% to 92%, demonstrating a relatively high accuracy. […] The above-mentioned data showed that we can rely on the scoring system for predicting the type of accreta and the degree of risk. […] The model of placenta accreta scoring system can be used to evaluate the type of accreta before operation, predict the risk of intraoperative bleeding, and has a certain significance in the reduction rate of fatal postpartum hemorrhage, hysterectomy rate of young women, and maternal mortality.

• #11

  https://journals.lww.com/md-journal/fulltext/2018/08310/an_ultrasonic_scoring_system_to_predict_the.71.aspx

  The study indicated that the accuracy of the scoring system for predicting the pathologic types of placenta accreta as 83.9% to 92%, demonstrating a relatively high accuracy. […] The above-mentioned data showed that we can rely on the scoring system for predicting the type of accreta and the degree of risk. […] This in turn avoided insufficient or excessive waste of blood preparation, reducing the potential maternal and children morbidity and mortality. […] The model of placenta accreta scoring system can be used to evaluate the type of accreta before operation, predict the risk of intraoperative bleeding, and has a certain significance in the reduction rate of fatal postpartum hemorrhage, hysterectomy rate of young women, and maternal mortality.

• #12

  https://journals.lww.com/md-journal/fulltext/2018/08310/an_ultrasonic_scoring_system_to_predict_the.71.aspx

  To discuss the value of self-made ultrasonic scoring system in predicting the different types of placenta accreta, and for predicting its associated risk of bleeding and hysterectomy. […] These results suggested that self-made ultrasonic scoring system remained an effective diagnostic tool for assessing the types of placenta accreta, and predicted the associated bleeding risk, indicating the possibility of hysterectomy. […] The main risks included are fatal postpartum hemorrhage and high hysterectomy rates in women of reproductive age. […] The risk of bleeding during operation and hysterectomy was high for increta/percreta. […] However, the existing ultrasound technology can only diagnose placenta accreta, but due to its low sensitivity it is far from the needs of clinicians. […] Hence, a model that can predict the prognosis of placenta accreta by ultrasound examination, and to solve the above clinical problems is required.

• #13

  https://journals.lww.com/md-journal/fulltext/2018/08310/an_ultrasonic_scoring_system_to_predict_the.71.aspx

  The study indicated that the accuracy of the scoring system for predicting the pathologic types of placenta accreta as 83.9% to 92%, demonstrating a relatively high accuracy. […] The above-mentioned data showed that we can rely on the scoring system for predicting the type of accreta and the degree of risk. […] This in turn avoided insufficient or excessive waste of blood preparation, reducing the potential maternal and children morbidity and mortality. […] The model of placenta accreta scoring system can be used to evaluate the type of accreta before operation, predict the risk of intraoperative bleeding, and has a certain significance in the reduction rate of fatal postpartum hemorrhage, hysterectomy rate of young women, and maternal mortality.

• #14 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #15 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #16 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #17 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  We put a caution note on the use of scoring systems, as more than ten scores are herein discussed, and none of them was superior to the others. Furthermore, none of the scores showed absolute accuracy in prediction of PAS disorders. […] Biomarkers measurements vary according to technique of estimation and gestational age. Sometimes, there were no differences and sometimes there was some overlap between cases and controls, and most studies were retrospective. Biomarkers are still investigational, and further assessment of these biomarkers in predicting PAS disorders should be kept for research purposes only.

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

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

  Placenta accreta is a pregnancy complication that occurs when the placenta embeds too deep in the uterine wall. […] The outlook is generally good when pregnancy care providers diagnose placenta accreta during pregnancy. However, there will be complications associated with preterm labor and a possible hysterectomy. If your obstetrician removes your uterus, you’ll lose the ability to become pregnant again. This condition can also lead to massive blood loss, injury to the bowel or bladder and even death. […] The survival rate of placenta accreta is generally good. In most cases, this means you’ll have a hysterectomy to prevent postpartum hemorrhaging or other severe complications.

• #19 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. […] A recently published study based on accreta deliveries between 1998-2011 found that while accreta was associated with as much as a 19-fold increase in adverse outcomes (including hysterectomy, transfusion and prolonged hospital stay), there were very few maternal deaths in their sample. […] It is important to note that in general, accreta moms keep their ovaries and do not go into menopause from an accreta related hysterectomy. […] 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. […] Accreta literature has previously indicated that better outcomes are achieved at a placenta accreta center of excellence, or at facilities with experience and expertise in treating accreta.

• #20 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The placenta accreta spectrum (PAS) is defined as a morbidly adherent placenta and includes placenta increta, accreta, and percreta. In recent years, the prevalence of PAS has increased and is currently estimated to be 1 out of 500 births. Despite advances in prenatal ultrasound and diagnosis and referral to experienced surgical centers, abnormal placentation remains one of the main causes for postpartum hemorrhage (PPH), increased maternal morbidity and mortality. Median blood loss during delivery in women diagnosed with PAS is estimated to be 3000 mL. In addition, >90.0% of all women with PAS receive red blood cell (RBC) transfusion during childbirth. Planned caesarean hysterectomy (HE) at the time of the delivery is the standard of care. Uterine artery embolization (UAE) is an alternative to caesarean HE, allowing preservation of the uterus and improvement of PPH, recommended by several national and international guidelines.

• #21 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The analysis of 17 women undergoing a two-step approach for treatment of PAS revealed that for caesarean delivery and subsequent UAE, the use of regional anesthesia (spinal or epidural anesthesia) is safe. After primary (76.5%) and secondary procedure (93.8%), postpartum anemia rate was high. In total, 62.7% of women received RBC transfusion during secondary procedure. Anemia management and the implementation of blood conservation strategies are crucial in women diagnosed with PAS undergoing UAE.

• #22 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. […] A recently published study based on accreta deliveries between 1998-2011 found that while accreta was associated with as much as a 19-fold increase in adverse outcomes (including hysterectomy, transfusion and prolonged hospital stay), there were very few maternal deaths in their sample. […] It is important to note that in general, accreta moms keep their ovaries and do not go into menopause from an accreta related hysterectomy. […] 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. […] Accreta literature has previously indicated that better outcomes are achieved at a placenta accreta center of excellence, or at facilities with experience and expertise in treating accreta.

• #23 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. […] 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. […] 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.

• #24 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The placenta accreta spectrum (PAS) is defined as a morbidly adherent placenta and includes placenta increta, accreta, and percreta. In recent years, the prevalence of PAS has increased and is currently estimated to be 1 out of 500 births. Despite advances in prenatal ultrasound and diagnosis and referral to experienced surgical centers, abnormal placentation remains one of the main causes for postpartum hemorrhage (PPH), increased maternal morbidity and mortality. Median blood loss during delivery in women diagnosed with PAS is estimated to be 3000 mL. In addition, >90.0% of all women with PAS receive red blood cell (RBC) transfusion during childbirth. Planned caesarean hysterectomy (HE) at the time of the delivery is the standard of care. Uterine artery embolization (UAE) is an alternative to caesarean HE, allowing preservation of the uterus and improvement of PPH, recommended by several national and international guidelines.

• #25 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. […] A recently published study based on accreta deliveries between 1998-2011 found that while accreta was associated with as much as a 19-fold increase in adverse outcomes (including hysterectomy, transfusion and prolonged hospital stay), there were very few maternal deaths in their sample. […] It is important to note that in general, accreta moms keep their ovaries and do not go into menopause from an accreta related hysterectomy. […] 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. […] Accreta literature has previously indicated that better outcomes are achieved at a placenta accreta center of excellence, or at facilities with experience and expertise in treating accreta.

• #26 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. […] A recently published study based on accreta deliveries between 1998-2011 found that while accreta was associated with as much as a 19-fold increase in adverse outcomes (including hysterectomy, transfusion and prolonged hospital stay), there were very few maternal deaths in their sample. […] It is important to note that in general, accreta moms keep their ovaries and do not go into menopause from an accreta related hysterectomy. […] 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. […] Accreta literature has previously indicated that better outcomes are achieved at a placenta accreta center of excellence, or at facilities with experience and expertise in treating accreta.

• #27 Placenta Accreta Spectrum | ACOG

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

  The antenatal diagnosis of placenta accreta spectrum is critical because it provides an opportunity to optimize management and outcomes. […] Taking these limited published data together, and the accepted approach of hysterectomy to treat placenta accreta spectrum, 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.

• #28 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The placenta accreta spectrum (PAS) is defined as a morbidly adherent placenta and includes placenta increta, accreta, and percreta. In recent years, the prevalence of PAS has increased and is currently estimated to be 1 out of 500 births. Despite advances in prenatal ultrasound and diagnosis and referral to experienced surgical centers, abnormal placentation remains one of the main causes for postpartum hemorrhage (PPH), increased maternal morbidity and mortality. Median blood loss during delivery in women diagnosed with PAS is estimated to be 3000 mL. In addition, >90.0% of all women with PAS receive red blood cell (RBC) transfusion during childbirth. Planned caesarean hysterectomy (HE) at the time of the delivery is the standard of care. Uterine artery embolization (UAE) is an alternative to caesarean HE, allowing preservation of the uterus and improvement of PPH, recommended by several national and international guidelines.

• #29 Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

  https://www.mdpi.com/2077-0383/13/4/1062

  The analysis of 17 women undergoing a two-step approach for treatment of PAS revealed that for caesarean delivery and subsequent UAE, the use of regional anesthesia (spinal or epidural anesthesia) is safe. After primary (76.5%) and secondary procedure (93.8%), postpartum anemia rate was high. In total, 62.7% of women received RBC transfusion during secondary procedure. Anemia management and the implementation of blood conservation strategies are crucial in women diagnosed with PAS undergoing UAE.

• #30 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #31 Early Prediction of Placenta Accreta Spectrum by Different Modalities: An Evidenced-based Analysis

  https://www.imrpress.com/journal/CEOG/51/1/10.31083/j.ceog5101027/htm

  Objective: Early prediction of placenta accreta is crucial for proper decision making, proper preoperative preparation and proper planning for the best management. […] Prediction of PAS has a lot of benefits, including reduction of peripartum complication, help decision-making and peripartum management, predict degree of severity, predict operative blood loss, and predict maternal morbidity and mortality. […] Early prediction of PAS allows good preparation of both patient and obstetrician to conduct the best management with minimal complications. PAS could be predicted early by either clinical risk factor, imaging in early pregnancy or by biomarkers. […] From this evidence-based analysis, we conclude that PAS disorders could be predicted by different modalities. Ultrasound markers are more accurate, easy to trace, and had positive correlation to PAS surgical outcomes, such as blood loss and peripartum hysterectomy.

• #32 An ultrasonic scoring system to predict the prognosis of placenta accreta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6392640/

  To discuss the value of self-made ultrasonic scoring system in predicting the different types of placenta accreta, and for predicting its associated risk of bleeding and hysterectomy. […] These results suggested that self-made ultrasonic scoring system remained an effective diagnostic tool for assessing the types of placenta accreta, and predicted the associated bleeding risk, indicating the possibility of hysterectomy. […] The study indicated that the accuracy of the scoring system for predicting the pathologic types of placenta accreta as 83.9% to 92%, demonstrating a relatively high accuracy. […] The above-mentioned data showed that we can rely on the scoring system for predicting the type of accreta and the degree of risk. […] The model of placenta accreta scoring system can be used to evaluate the type of accreta before operation, predict the risk of intraoperative bleeding, and has a certain significance in the reduction rate of fatal postpartum hemorrhage, hysterectomy rate of young women, and maternal mortality.

• #33

  https://journals.lww.com/md-journal/fulltext/2018/08310/an_ultrasonic_scoring_system_to_predict_the.71.aspx

  The study indicated that the accuracy of the scoring system for predicting the pathologic types of placenta accreta as 83.9% to 92%, demonstrating a relatively high accuracy. […] The above-mentioned data showed that we can rely on the scoring system for predicting the type of accreta and the degree of risk. […] This in turn avoided insufficient or excessive waste of blood preparation, reducing the potential maternal and children morbidity and mortality. […] The model of placenta accreta scoring system can be used to evaluate the type of accreta before operation, predict the risk of intraoperative bleeding, and has a certain significance in the reduction rate of fatal postpartum hemorrhage, hysterectomy rate of young women, and maternal mortality.

• #34 Risk Factors, Prognosis and Prediction Models for Placenta Accreta Without Prior Cesarean Section | Clinical Research Trial Listing

  https://www.centerwatch.com/clinical-trials/listings/NCT06383923/risk-factors-prognosis-and-prediction-models-for-placenta-accreta-without-prior-cesarean-section

  Clarify the prognostic factors of the disease and explore individualized treatment options to improve the prognosis of patients with this type of disease; […] The placenta accreta spectrum (PAS) is defined as abnormal placental trophoblast adherence with a wide range of myometrial invasion. It is a serious pregnancy complication that can lead to severe postpartum hemorrhage, which may necessitate hysterectomy, and could ultimately lead to maternal death. […] This study aims to explore the risk factors and prognosis of PAS without a history of cesarean section and try to establish the prediction model.

• #35 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

  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. […] In conclusion, our data revealed that approximately one-third of PAS cases were not suspected during antenatal screening, and these unsuspected cases exhibited poorer outcomes compared to the suspected cases. Risk factors for lack of suspicion include a history of intrauterine adhesions, clinically confirmed PAS, posterior placenta, and placenta previa. Increasing awareness of these risk factors could facilitate early diagnosis of PAS and enhance maternal outcomes.

• #36 Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7653210/

  Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. […] However, since diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively. […] In conclusion, in our cohort, diagnosis of placenta accreta was first made intraoperatively in nearly a third of cesarean hysterectomies. While most patients undergoing cesarean hysterectomy for clinically diagnosed placenta accreta had the diagnosis confirmed on pathologic examination, there was a 4% false positive rate. […] These findings re-enforce the need for vigilance intraoperatively as the need for cesarean hysterectomy may not be anticipated preoperatively.

• #37 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. […] 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. […] 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.

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