Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam – literature review and authors’ experience

Abstract

The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.

Termination of a second-trimester pregnancy with placenta accreta spectrum disorder

“…Notably, ultrasound markers indicative of PASD and serum diagnostic markers, such as human chorionic gonadotropin, can manifest during the first trimester, enabling assessment and prediction of PASD severity in the first and second trimesters [ 12–14 ]. Early intervention can enhance pregnancy outcomes [ 13 , 15 ].…”

Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum

“…A total of 532 pregnant women who delivered in the Third Affiliated Hospital of Zhengzhou University between January 2021 and December 2022 underwent ultrasound to evaluate placental invasion. Inclusion criteria were: (1) high-risk for placenta accreta [ 3 , 11 , 17 , 27 – 29 ] due to history of surgery (cesarean section, uterine myomectomy, labor induction, uterine curettage, induced abortion), placenta previa, primary uterine abnormalities (bicornuate uterus, adenomyosis, submucosal myoma), smoking, and/or advanced age; (2) gestational age ≥ 28 weeks; and (3) singleton pregnancy. Exclusion criteria were (1) serious diseases of the heart, brain, liver, kidney and other organs; or (2) abnormal coagulation function or malignant tumors.…”

“…Evidence suggests that one-half to two-thirds of PAS cases remain undiagnosed before delivery [ 14 , 15 ], including approximately one-third of PAS cases in specialist centers [ 16 ]. The sensitivity and specificity of various ultrasound features for PAS change across the spectrum of placental invasion [ 8 , 17 ], and there is significant interobserver variability in the interpretation of placental invasion [ 8 , 18 ] as most ultrasound features are poorly defined [ 19 ]. At present, there is no consensus on a diagnostic standard for PAS.…”

Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

“…With the rising number of prior cesarean sections, the incidence of PAS is also growing, a trend expected to continue [ 6 , 7 ]. The presence of PAS poses significant risks including hysterectomy, intrapartum and postpartum hemorrhage, and maternal morbidity and mortality [ 8 , 9 , 10 ].…”