Systematic review on near miss cases of placenta accreta spectrum disorders: correlation with invasion topography, prenatal imaging, and surgical outcome

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

“…However, recent population studies from the UK, the USA, and northern Europe have shown that AIP remains undiagnosed before delivery in between half to two thirds of cases [8][9][10]. Reasons include limited availability of specialized ultrasound scans that are able to detect the frequently subtle ultrasound features of AIP entities such as invasion of the lower posterior bladder wall or the parametria [11][12][13]. Therefore, suitable maternal serum biomarkers might aid doctors additionally to ultrasound in gynecological practices worldwide in detecting AIP early and for planning the appropriate management for pregnant women with AIP [14][15][16].…”

Comparing three‐dimensional models of placenta accreta spectrum with surgical findings

“…Historically the focus has been on the depth of invasion of the placenta, however the anatomical site of invasion and the size of the myometrial defect may be a more important predictor of massive blood loss [9,10]. An understanding of the anatomical invasive margins (invasive topography) is important as they are often related to a specific vascular pedicle.…”

“…Although rare, lateral parametrial invasions are often associated with illegal abortions, manual removal of the placenta and repeated curettage. There are two types of lateral invasions, one in which the placenta protrudes through a lateral defect, similar to a hernia, and the another, in which primary lateral embryo implantation occurs leading to extensive neo-angiogenesis (Figure 1) [9]. The fourth and final area of topographic invasion is posterior lower uterine body invasions, which are much more difficult to diagnose antenatally.…”

Possible limitation to use the International Federation of Gynecology and Obstetrics classification of placenta accreta spectrum

“…Both locations have completely different possibilities for blood loss or complications and are not comparable. 4 To create standardized perinatal diagnostic protocols and to obtain valuable epidemiologic data, all comparable series should follow the same methodology. In contrast, topographic classification of PAS is associated with simpler and fixed parameters, 4 such as pedicles in a specific area, and technical local problems, such as narrow space, presence of the ureter, etc.…”

“…4 To create standardized perinatal diagnostic protocols and to obtain valuable epidemiologic data, all comparable series should follow the same methodology. In contrast, topographic classification of PAS is associated with simpler and fixed parameters, 4 such as pedicles in a specific area, and technical local problems, such as narrow space, presence of the ureter, etc. Dr Jauniaux's study has demonstrated that these results could be a limitation of the FIGO classification and that such categorization still needs revision and a prospective validation before being used in clinical practice.…”