Placenta accreta spectrum

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A spectrum of conditions involving abnormal placental attachment

Placenta accreta spectrum
Synonyms	Placenta accreta, placenta increta, placenta percreta
Pronounce	N/A
Specialty	N/A
Symptoms	Vaginal bleeding during the third trimester, abdominal pain
Complications	Severe hemorrhage, hysterectomy, preterm birth
Onset	During pregnancy
Duration	Until delivery
Types	N/A
Causes	Abnormal attachment of the placenta to the uterine wall
Risks	Previous cesarean section, placenta previa, advanced maternal age
Diagnosis	Ultrasound, MRI
Differential diagnosis	Placental abruption, uterine rupture
Prevention	Planned cesarean delivery with hysterectomy if necessary
Treatment	Cesarean section, hysterectomy
Medication	N/A
Prognosis	Variable, depends on severity and management
Frequency	1 in 533 pregnancies
Deaths	N/A

The placenta accreta spectrum (PAS) refers to a range of conditions characterized by abnormal attachment of the placenta to the uterine wall. This spectrum includes placenta accreta, placenta increta, and placenta percreta, each defined by the depth of placental invasion into the uterine tissues.

Types of Placenta Accreta Spectrum

Placenta Accreta

In placenta accreta, the placenta attaches too deeply into the uterine wall but does not penetrate the myometrium. This is the most common form of PAS and can lead to complications during childbirth, particularly during the third stage of labor when the placenta is delivered.

Placenta Increta

Placenta increta occurs when the placenta invades the myometrium more deeply than in placenta accreta. This condition poses a higher risk of postpartum hemorrhage and may require surgical intervention to manage.

Placenta Percreta

The most severe form of PAS is placenta percreta, where the placenta penetrates through the entire uterine wall and may invade adjacent organs, such as the bladder. This condition often necessitates a hysterectomy to control bleeding and prevent further complications.

Risk Factors

Several factors increase the risk of developing PAS, including:

• Previous cesarean section
• Placenta previa
• Advanced maternal age
• Previous uterine surgery
• Multiparity

Diagnosis

PAS is typically diagnosed through ultrasound imaging, which can reveal abnormal placental attachment. In some cases, magnetic resonance imaging (MRI) may be used to assess the extent of placental invasion.

Management

Management of PAS requires a multidisciplinary approach involving obstetricians, anesthesiologists, and surgeons. Delivery is often planned via cesarean section in a controlled setting to minimize risks. In severe cases, a hysterectomy may be necessary to prevent life-threatening hemorrhage.

Prognosis

The prognosis for PAS varies depending on the severity of the condition and the promptness of treatment. With appropriate management, many women can have successful outcomes, although the risk of complications remains significant.

See also

• Placenta
• Cesarean section
• Postpartum hemorrhage
• Hysterectomy