Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies

Maddalena Morlando, Sally Collins, Maddalena Morlando, Sally Collins

Abstract

The worldwide incidence of placenta accreta spectrum (PAS) is rapidly increasing, following the trend of rising cesarean delivery. PAS is an heterogeneous condition associated with a high maternal morbidity and mortality rate, presenting unique challenges in its diagnosis and management. So far, the rarity of this condition, together with the absence of high quality evidence and the lack of a standardized approach in reporting PAS cases for the ultrasound, clinical, and pathologic diagnosis, represented the main challenges for a deep understanding of this condition. The study of the available management strategies of PAS has been hampered by the heterogeneity of the available epidemiological data on this condition. The aim of this review is to provide a critical view of the current available evidence on the screening, the diagnosis, and the management options for PAS disorders, with a special focus on the challenges we foresee for the near future.

Keywords: abnormal invasive placenta; abnormal placentation; morbidly adherent placenta; placenta accreta; placenta accreta spectrum.

Conflict of interest statement

The authors report no conflicts of interest for this work.

© 2020 Morlando and Collins.

Figures

Figure 1
Figure 1
Placenta percreta, showing aberrant neovascularization of the lower uterine segment. This extends down behind the urinary bladder (this can just be seen at the top of the bladder).
Figure 2
Figure 2
PAS includes both abnormally adherent placenta (placenta accreta) and abnormally invasive placenta (AIP – including placenta increta and placenta percreta). In the abnormally adherent placenta the implantation of the villi is in direct contact with the myometrium in the absence of an obvious plane of cleavage, while in the AIP the villi invade deeply into the myometrium and surrounding organs. FIGO defines these as Grades 1, 2, and 3.
Figure 3
Figure 3
A uterine window. The placenta is seen directly below the serosa at the site of a uterine dehiscence – note the completely normal appearance of the surrounding myometrium. These dehiscences can be extremely large, resulting in a huge bulge of placental tissue which can appear very alarming, leading to an incorrect diagnosis of PAS.

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