Diagnosis and Management of Cesarean Scar Pregnancy and Placenta Accreta Spectrum

Panaitescu, Anca Maria; Ciobanu, Anca Marina; Gică, Nicolae; Peltecu, Gheorghe; Botezatu, Radu

doi:10.1002/jum.15574

Cited by 10 publications

(10 citation statements)

References 46 publications

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“…A correct histopathological diagnosis and the adoption of FIGO classification criteria also allow a reassessment of the epidemiological data [ 40 ]. Unfortunately, the histological diagnosis cannot be obtained in case of the expectant management of PAS [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders

et al. 2022

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Management strategies for pregnancies with abnormal adherence/invasion of the placenta (placenta accreta spectrum, PAS) vary between centers. Expectant management (EM), defined as leaving the placenta in situ after the delivery of the baby, until its complete decomposition and elimination, has become a potential option for PAS disorders in selected cases, in which the risk of Caesarean hysterectomy is very high. However, expectant management has its own risks and complications. The aim of this study was to describe the rates of subsequent hysterectomy (HT) in patients that underwent EM for the treatment of PAS disorders. We reviewed the literature on the subject and found 12 studies reporting cases of HT after initial intended EM. The studies included 1918 pregnant women diagnosed with PAS, of whom 518 (27.1%) underwent EM. Out of these, 121 (33.2%) required subsequent HT in the 12 months following delivery. The rates of HT after initial EM were very different between the studies, ranging from 0 to 85.7%, reflecting the different characteristics of the patients and different institutional management protocols. Prospective multicenter studies, in which the inclusion criteria and management strategies would be uniform, are needed to better understand the role EM might play in the treatment of PAS disorders.

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Section: Discussionmentioning

confidence: 99%

Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders

et al. 2022

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“…The median age was 31.0 years (range 24-38), and gravidity ranged from two to five. The median duration of gestation at diagnosis was 8.2 weeks (range [6][7][8][9][10][11]. The median interval between the current CSP and previous cesarean section was 2.5 years (range 1-7) (Table 1).…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…Resection of gestational contents can be accomplished either through operative hysteroscopy or laparoscopy, and transcervical vacuum suction has been proposed as a minimally invasive treatment option 8 . Extravillous trophoblast cells (EVTs) can invade deeply into the myometrium or beyond the uterine serosa, resulting in placenta accreta spectrum disorders, including accreta, increta, and percreta, which are potentially life‐threatening because of associated massive hemorrhage events 9,10 . The pathophysiology of the placenta accreta spectrum is thought to involve excessive trophoblast invasion or/and defective decidua 11 .…”

Section: Introductionmentioning

confidence: 99%

“… 8 Extravillous trophoblast cells (EVTs) can invade deeply into the myometrium or beyond the uterine serosa, resulting in placenta accreta spectrum disorders, including accreta, increta, and percreta, which are potentially life‐threatening because of associated massive hemorrhage events. 9 , 10 The pathophysiology of the placenta accreta spectrum is thought to involve excessive trophoblast invasion or/and defective decidua. 11 However, rather than abnormal invasion, the deep implantation of a CSP appears to be due to endometrial/decidual defects under the implantation site.…”

Section: Introductionmentioning

confidence: 99%

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Extravillous trophoblast invasion and decidualization in cesarean scar pregnancies

Gao

Chen

Liu

et al. 2022

Acta Obstet Gynecol Scand

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Introduction:The increasing cesarean section rate has led to an increase in the number of subsequent pregnancies resulting in a cesarean scar pregnancy. There appears to be preferential attachment of the blastocyst to the scar site, which may be associated with defective decidua in that region, resulting in abnormal implantation, which can in turn negatively affect the success of the pregnancy. The aim of the current study was to evaluate the extravillous trophoblast, decidua, and myometrium in scar and adjacent non-scar regions of the implantation site of a cesarean scar pregnancy.Material and Methods: Samples containing a gestational mass were obtained by laparoscopic excision from patients with a cesarean scar pregnancy at 6-11 weeks of gestation as diagnosed by transvaginal or transabdominal ultrasound (n = 8 type II cesarean scar pregnancy). Cesarean scar pregnancy tissues were separated into scar and non-scar regions, and the scar regions were sub-separated into non-implantation and implantation sites. Serial sections were histologically examined after hematoxylin and eosin, Masson's trichrome and immunochemical staining, and changes in the myometrium, extravillous trophoblast, and decidua were evaluated. Results:In cesarean scar pregnancy, compared with scars not in the implantation site, scars in the implantation site displayed increased fibrosis, and had disrupted myometrium, which was related to varying patterns of E-cadherin expression as a response to extravillous trophoblast invasion. In addition, local decidua was found at the non-scar implantation sites, with multinucleated trophoblast giant cell accumulation and shallow invasion. These features were not evident in the scar implantation sites. Conclusions:This study emphasizes that the decidua drives multinucleated trophoblast giant cell differentiation, limiting the degree of invasion. Better characterization of this differentiation process may be helpful for better management and avoidance of the consequences of cesarean scar pregnancy.

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“… [5] PAS is associated with increased morbidity and mortality for the pregnant person and fetus due to complications with hemorrhage and preterm labor [6] . Previous cesarean section is a risk factor for PAS and a cesarean scar ectopic pregnancy is considered a precursor for PAS [ 7 , 8 ]. Diagnosis of both a cesarean scar ectopic pregnancy as well as the development and severity of placenta accreta are critical as this can be a life-threatening condition complicated by uterine rupture and/or severe hemorrhage [3] .…”

Section: Introductionmentioning

confidence: 99%

Dichorionic diamniotic heterotopic twin gestation with cesarean section scar implantation and placenta increta

Wang,

Vaught,

Rosner

et al. 2023

Radiology Case Reports

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Diagnosis and Management of Cesarean Scar Pregnancy and Placenta Accreta Spectrum

Cited by 10 publications

References 46 publications

Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders

Risk of Subsequent Hysterectomy after Expectant Management in the Treatment of Placenta Accreta Spectrum Disorders

Extravillous trophoblast invasion and decidualization in cesarean scar pregnancies

Dichorionic diamniotic heterotopic twin gestation with cesarean section scar implantation and placenta increta

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