-
Acta Obstetricia Et Gynecologica... Feb 2014Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim... (Review)
Review
Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance.
Topics: Blood Loss, Surgical; Blood Volume; Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Pregnancy Complications; Treatment Outcome; Uterine Artery Embolization
PubMed: 24266548
DOI: 10.1111/aogs.12295 -
BJOG : An International Journal of... Jan 2014The incidence of placental attachment disorders continues to increase with rising caesarean section rates. Antenatal diagnosis helps in the planning of location, timing... (Review)
Review
The incidence of placental attachment disorders continues to increase with rising caesarean section rates. Antenatal diagnosis helps in the planning of location, timing and staffing of delivery. In at-risk women grey-scale ultrasound is quite sensitive, although colour ultrasound is the most predictive. Magnetic resonance imaging can add information in some limited instances. Patients who have had a previous caesarean section could benefit from early (before 10 weeks) visualisation of the implantation site. Current data refer only to placentas implanted in the lower anterior uterine segment, usually over a caesarean section scar.
Topics: Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Myometrium; Placenta Accreta; Predictive Value of Tests; Pregnancy; Pregnancy Trimesters; Prenatal Diagnosis; Sensitivity and Specificity; Ultrasonography, Doppler, Color
PubMed: 24373591
DOI: 10.1111/1471-0528.12557 -
Taiwanese Journal of Obstetrics &... Mar 2009
Topics: Female; Humans; Imaging, Three-Dimensional; Placenta Accreta; Placenta Previa; Pregnancy; Ultrasonography, Doppler, Color
PubMed: 19346184
DOI: 10.1016/S1028-4559(09)60027-9 -
Taiwanese Journal of Obstetrics &... Mar 2022
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 35361376
DOI: 10.1016/j.tjog.2022.02.004 -
The New England Journal of Medicine Oct 2016
Topics: Adult; Female; Humans; Placenta; Placenta Accreta; Pregnancy; Ultrasonography, Prenatal
PubMed: 27705250
DOI: 10.1056/NEJMicm1513423 -
Disease Markers 2018. Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe... (Review)
Review
. 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.
Topics: Biomarkers; Female; Fetal Proteins; Gonadotropins; Humans; Placenta Accreta; Pregnancy; Pregnancy-Associated Plasma Protein-A
PubMed: 30057649
DOI: 10.1155/2018/1507674 -
PloS One 2012Placenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the...
BACKGROUND
Placenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors.
METHODS
A national case-control study using the UK Obstetric Surveillance System was undertaken, including 134 women diagnosed with placenta accreta/increta/percreta between May 2010 and April 2011 and 256 control women.
RESULTS
The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall; 577 per 10,000 in women with both a previous caesarean delivery and placenta praevia. Women who had a previous caesarean delivery (adjusted odds ratio (aOR) 14.41, 95%CI 5.63-36.85), other previous uterine surgery (aOR 3.40, 95%CI 1.30-8.91), an IVF pregnancy (aOR 32.13, 95%CI 2.03-509.23) and placenta praevia diagnosed antepartum (aOR 65.02, 95%CI 16.58-254.96) had raised odds of having placenta accreta/increta/percreta. There was also a raised odds of placenta accreta/increta/percreta associated with older maternal age in women without a previous caesarean delivery (aOR 1.30, 95%CI 1.13-1.50 for every one year increase in age).
CONCLUSIONS
Women with both a prior caesarean delivery and placenta praevia have a high incidence of placenta accreta/increta/percreta. There is a need to maintain a high index of suspicion of abnormal placental invasion in such women and preparations for delivery should be made accordingly.
Topics: Adult; Case-Control Studies; Cesarean Section; Epidemiological Monitoring; Female; Humans; Incidence; Maternal Age; Odds Ratio; Placenta Accreta; Placenta Previa; Pregnancy; Risk Factors; United Kingdom
PubMed: 23300807
DOI: 10.1371/journal.pone.0052893 -
International Journal of Gynaecology... Mar 2018To review a single-center case series of placenta percreta and to evaluate risk factors and the impact of surgical techniques used in previous cesarean delivery.
OBJECTIVE
To review a single-center case series of placenta percreta and to evaluate risk factors and the impact of surgical techniques used in previous cesarean delivery.
METHODS
The present retrospective cohort study included pregnancies with placenta percreta managed between January 1, 2002, and March 31, 2017, at Saint Luc University Hospital, Brussels, Belgium. The data reviewed included demographics, outcomes, inter-pregnancy interval, and surgical techniques used for uterine closure in previous cesarean delivery. A cases series of non-accreta placenta previa was used as a control group.
RESULTS
There were 19 pregnancies included in the study. The most common ultrasonography signs in the study group were loss of the clear zone (14/17; 82%), placental lacunae (17/17; 100%), and subplacental hypervascularity (11/14; 79%). Median gravidity, parity, and number of previous cesarean deliveries were higher (P<0.05) and inter-pregnancy interval was longer (P<0.05) in the study group than the control group. There was no difference between the groups in the surgical techniques used for previous cesarean deliveries.
CONCLUSION
The prenatal ultrasonography diagnosis of placenta percreta is accurate and facilitates optimal management by a specialized multidisciplinary team. Multicenter studies are required to further evaluate the impact of the surgical techniques used for prior cesarean delivery on the risks of placenta percreta in subsequent pregnancies.
Topics: Adult; Case-Control Studies; Cesarean Section; Cohort Studies; Female; Gravidity; Humans; Parity; Placenta; Placenta Accreta; Pregnancy; Retrospective Studies; Risk Factors; Ultrasonography, Prenatal
PubMed: 29194617
DOI: 10.1002/ijgo.12412 -
Reproductive Sciences (Thousand Oaks,... Apr 2022In placenta percreta cases, large vessels are present on the precrete surface area. As these vessels are not found in normal placentation, we examined their histological...
In placenta percreta cases, large vessels are present on the precrete surface area. As these vessels are not found in normal placentation, we examined their histological structure for features that might explain the pathogenesis of neoangiogenesis induced by placenta accreta spectrum disorders (PAS). In two patients with placenta percreta (FIGO grade 3a) of the anterior uterine wall, one strikingly large vessel of 2 cm length was excised. The samples were formalin fixed and paraffin-embedded. Gomori trichrome staining was used to evaluate the muscular layers and Weigert-Van Gieson staining for elastic fibers. Immunohistochemical staining of the vessel endothelium was performed for Von Willebrand factor (VWF), platelet endothelial cell adhesion molecule (CD31), Ephrin B2, and EPH receptor B4. The structure of the vessel walls appeared artery-like. The vessel of patient one further exhibited an unorderly muscular layer and a lack of elastic laminae, whereas these features appeared normal in the vessel of the other patient. The endothelium of both vessels stained VWF-negative and CD31-positive. In conclusion, this study showed VWF-negative vessel endothelia of epiplacental arteries in placenta accreta spectrum. VWF is known to regulate artery formation, as the absence of VWF has been shown to cause enhanced vascularization. Therefore, we suppose that PAS provokes increased vascularization through suppression of VWF. This process might be associated with the immature vessel architecture as found in one of the vessels and Ephrin B2 and EPH receptor B4 negativity of both artery-like vessels. The underlying pathomechanism needs to be evaluated in a greater set of patients.
Topics: Arteries; Endothelium, Vascular; Ephrin-B2; Female; Humans; Neovascularization, Pathologic; Placenta Accreta; Pregnancy; Receptor, EphB4; von Willebrand Factor
PubMed: 34766259
DOI: 10.1007/s43032-021-00763-4 -
Archives of Gynecology and Obstetrics Dec 2019The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study...
PURPOSE
The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa.
METHODS
This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher's exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI).
RESULTS
We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8-3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1-9.6).
CONCLUSIONS
Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.
Topics: Adult; Female; Humans; Hysterectomy; Morbidity; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies
PubMed: 31691015
DOI: 10.1007/s00404-019-05338-y