Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers

Helena C Bartels, James D Postle, Paul Downey, Donal J Brennan, Helena C Bartels, James D Postle, Paul Downey, Donal J Brennan

Abstract

Background. Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.

Figures

Figure 1
Figure 1
Histopathology of placenta accreta syndrome. (a) High-power picture of decidualised endometrium as a result of pregnancy. Stromal cells are large, pale, and polygonal. (b) Low-power image of decidualised endometrium on the surface with underlying congested myometrial blood vessels and myometrium. (c) Low-power image of PAS showing chorionic villi in direct contact with myometrium (no intervening decidua). (d) Chorionic villus with polar trophoblast invading myometrial muscle. (e) Nonadherent area of the same placenta where decidua is seen between villi (bottom right) and myometrium (top left). (f) PAS—chorionic villi in direct contact with muscle; a multinucleated extravillous trophoblast is seen in the top right.
Figure 2
Figure 2
Similarities between PAS and cancer. Figure showing the 8 hallmarks of cancer as described by Weinberg and Hannahan and the similarities to the molecular biology of PAS [18].

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Source: PubMed

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