Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists

Touhami, Omar; Allen, Lisa; Mendoza, Hector; Murphy, Michelle; Hobson, Sebastian

doi:10.1136/ijgc-2021-003325

Cited by 11 publications

(5 citation statements)

References 53 publications

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“…Over the past decades, the incidence of PAS has increased dramatically with a growing rate of cesarean sections and the reported prevalence of PAS in China is 2.2%, higher than in other countries 5 . PAS have emerged as an ongoing major iatrogenic public health challenge in the 21st century 6 . Although some progress has been made in the diagnosis and surgical treatment of PAS in recent years, its etiology is largely uncertain 7,8 .…”

Section: Introductionmentioning

confidence: 99%

“…5 PAS have emerged as an ongoing major iatrogenic public health challenge in the 21st century. 6 Although some progress has been made in the diagnosis and surgical treatment of PAS in recent years, its etiology is largely uncertain. 7,8 The accumulating evidences have confirmed that molecular and phenotypic similarities between PAS and cancer.…”

Section: Introductionmentioning

confidence: 99%

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Overexpressed LAMC2 promotes trophoblast over‐invasion through the PI3K/Akt/MMP2/9 pathway in placenta accreta spectrum

Wang

Liu

Zhao

et al. 2022

J of Obstet and Gynaecol

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Background Placenta accreta spectrum (PAS) is an ongoing major iatrogenic public health challenge with devastating obstetric complications, but its underlying molecular pathogenesis remains poorly illuminated. LAMC2 is reported to regulate tumor cells proliferation and invasion, yet has not been explored in placenta trophoblast cells. This study investigated LAMC2 expression and its contribution in the etiology of PAS. Methods Quantitative polymerase chain reaction, western blot, and immunohistochemistry were performed to detect the expression of LAMC2 in placentas. Cell proliferation, invasion, migration, and apoptosis were monitored by CCK8 assay, wound healing assay, transwell invasion assay, and flow cytometry assay. Western blot was conducted to confirm the pertinent proteins level of PI3K/Akt/MMP2/9 pathway in HTR8/SVneo cells. Results LAMC2 was predominantly expressed in placental villous syncytiotrophoblasts and cytotrophoblasts. LAMC2 mRNA and protein expression were substantially upregulated in placental tissues with PAS compared to those with pernicious placenta previa without PAS. LAMC2 overexpression eminently boosted HTR8/SVneo cells proliferation, invasion, and migration, but inhibited apoptosis, accompanied by elevated protein expression of MMP2, MMP9, and phosphorylated Akt (pAkt). Knockdown of LAMC2 yielded the converse results. Additionally, when treated with LY294002, the effects of LAMC2 overexpression on proliferation, migration, invasion, and apoptosis of HTR8/SVneo cells were abolished and concomitantly the elevated pAkt, MMP2, and MMP9 proteins induced by LAMC2 overexpression were eliminated. Conclusion Our study highlighted the involvement of LAMC2 in the pathogenesis of PAS by activating the PI3K/Akt/MMP2/9 signaling pathway to stimulate trophoblast over‐invasion. These findings provide a new target for the diagnosis and disease stratification of PAS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overexpressed LAMC2 promotes trophoblast over‐invasion through the PI3K/Akt/MMP2/9 pathway in placenta accreta spectrum

Wang

Liu

Zhao

et al. 2022

J of Obstet and Gynaecol

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“…As the incidence of PAS rises, and with the growing experience of the MDTs, the management of this condition is constantly evolving. 25 An example of this is the recently described Soleymani-Alazzam-Collins (SAC) technique regarding the surgical treatment of severe PAS. 26 Our center has also adopted a similar approach over the years, getting closer to the SAC technique in some points, such as the transversal skin incision, the identification and slinging of the ureters without catheter placement, and the identification of the common and internal iliac arteries (with the objective of reducing the need for balloons in the common iliac arteries).…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum Disorders – The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal

Teixeira,

Pinto,

Realista

et al. 2023

Rev Bras Ginecol Obstet

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Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group – 2010–2014; and MDT group – 2015–2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy – one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

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“…Despite these study limitations, the findings of current study suggest that gynecologic oncologists are actively involved and express an interest in placenta accreta spectrum surgery in the USA. A 2022 expert review stated that gynecologic oncologists are encouraged to be proactively involved in the management of patients with placenta accreta spectrum 19. Their recommendations address not only the area of intraoperative surgical consultation, but also clinical protocol and guideline development.…”

Section: Discussionmentioning

confidence: 99%

Gynecologic oncologists in surgery for placenta accreta spectrum: a survey for practice, experience, and interest

Matsuo

Vestal

Rau

et al. 2022

Int J Gynecol Cancer

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ObjectiveSurgery for placenta accreta spectrum is associated with significant maternal morbidity and mortality. The role of gynecologic oncologists in the surgical management of placenta accreta spectrum is currently under investigation. This study examined the practices, experiences, and interests of gynecologic oncologists in placenta accreta spectrum surgeries.MethodsThe intervention was an anonymous, cross-sectional, 20-question survey sent to 1084 members of the Society of Gynecologic Oncology in the USA.ResultsA total of 184 gynecologic oncologists responded to the survey (response rate 17.0%). Most participating gynecologic oncologists have been practicing for >10 years after fellowship (53.2%), practice in urban-teaching hospitals (84.8%) with delivery volumes ≥3000/year (54.3%), and have a multidisciplinary approach (82.5%). Three-quarters (78.7%) feel that the rate of placenta accreta spectrum is increasing over time. One-third (35.5%) perform ≥6 hysterectomies for placenta accreta spectrum yearly. Less than half (45.5%) practice conservative management. Approximately half are involved from the beginning of the case (49.7%) and perform the surgery in the main operating room (59.4%). Almost three-quarters (71.6%) have experienced surgical blood loss >5 L and one-third (36.6%) have experienced cases with blood loss >10 L. About half (50.3%) of participants are interested in placenta accreta spectrum surgery for future practice. Gynecologic oncologists engaging in a multidisciplinary approach are more likely to practice in an urban-teaching hospital, have higher surgical volume, be involved from the beginning of the case, and be interested in placenta accreta spectrum surgery. Those >10 years post-training and in the Southern US region are more likely to practice conservative management or delayed hysterectomy.ConclusionThis society-based cross-sectional survey suggests that gynecologic oncologists are actively involved in the surgical management of placenta accreta spectrum in the USA. Nearly half of gynecologic oncologists who responded to the survey expressed interest in surgery for placenta accreta spectrum.

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Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists

Cited by 11 publications

References 53 publications

Overexpressed LAMC2 promotes trophoblast over‐invasion through the PI3K/Akt/MMP2/9 pathway in placenta accreta spectrum

Overexpressed LAMC2 promotes trophoblast over‐invasion through the PI3K/Akt/MMP2/9 pathway in placenta accreta spectrum

Placenta Accreta Spectrum Disorders – The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal

Gynecologic oncologists in surgery for placenta accreta spectrum: a survey for practice, experience, and interest

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