Placenta accreta spectrum: ultrasound diagnosis and clinical correlation

Abstract

The abnormal invasive placenta is a unique pathological condition, and it occurs only in humans. The definitions, classifications, and ultrasound markers for pathological placental attachment are being developed to unify and standardize. Placenta accreta spectrum (PAS) is a clinical situation rather than an isolated condition in which the placenta does not separate spontaneously from the uterine wall after the delivery of the fetus, and all added forceful methods for its separation lead to massive life-threatening hemorrhage. Morbidity and mortality in such situations are increasing; therefore, the involvement of a multidisciplinary team is important. The main risk factors are previous caesarean section and placenta previa. The PAS rate increases in proportion to the increase in the frequency of Sectio Caesarea (SC). The final diagnosis is made by ultrasound Grayscale color Doppler and 3D in the third trimester after 28–30 weeks of gestation. The most common and correct treatment is peripartum hysterectomy. This mini-review provides an overview of PAC, interpreted as a life-threatening disorder (the new terminology for placenta accreta). We present ultrasound findings collected over an 11-year prospective period of examination of over 58 cases of placenta accreta, of which 53 ended with peripartal hysterectomy and 5 partial accreta, which ended with preservation of the uterus, histologically approved. The markers of PAS are presented based on the criteria of FIGO and ACOG in correlation with intraoperative findings and pathohistological examination.

Keywords:

• Ultrasound markers
• placenta accreta spectrum
• abnormal placental invasion

Data availability

All anonymized data that support the findings from this study are available from the corresponding author [N.G.] upon reasonable request.

Disclosure statement of interest

The authors report no conflict of interest.

Ethics statement

The appropriate ethics review and informed consent protocols have been followed.

Author contribution statements

M.Ts., M.K., and N.G. contributed to the design and implementation of the study, to the analysis of the results, and to the writing of the manuscript. All authors have read and approved the final version of the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s)

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.