Placenta accreta spectrum

Placenta accreta spectrum (PAS) is a complication of pregnancy characterized by the abnormal adherence of the placenta to the myometrium, the middle layer of the wall of the uterus. It is a significant cause of maternal mortality and morbidity worldwide.

Classification

PAS is classified into three types based on the depth of placental invasion into the uterine wall:

• Placenta accreta: The placenta attaches too deeply and firmly, but it does not penetrate the uterine muscle.
• Placenta increta: The placenta attaches even more deeply, invading the muscle.
• Placenta percreta: The placenta penetrates through the entire uterine wall and can attach to other organs such as the bladder.

Risk factors

The primary risk factor for PAS is placenta previa in the presence of a uterine scar, typically from a previous cesarean section. Other risk factors include advanced maternal age, high parity, and previous uterine surgery or curettage.

Diagnosis

PAS is typically diagnosed through ultrasound during the second or third trimester of pregnancy. Magnetic resonance imaging (MRI) may also be used if ultrasound results are inconclusive.

Treatment

The treatment for PAS is usually planned cesarean delivery followed by hysterectomy. In some cases, conservative management may be considered, where the placenta is left in place and allowed to resorb naturally.

Prognosis

The prognosis for PAS depends on the severity of the condition, the woman's overall health, and the quality of medical care received. With appropriate management, most women with PAS can expect a good outcome.

See also

• Placenta previa
• Cesarean section
• Maternal mortality

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