New Evidence-Based Diagnostic and Management Strategies for Placenta Accreta Spectrum Disorders

Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:75-88. doi: 10.1016/j.bpobgyn.2019.04.006. Epub 2019 Apr 30.

Abstract

The increasing incidence of caesarean delivery (CD) has resulted in an increase in placenta accreta spectrum (PAS), adversely impacting maternal outcomes globally. Currently, more than 90% of women diagnosed with PAS present with a placenta praevia (praevia PAS). Praevia PAS can be reliably diagnosed antenatally with ultrasound, and it is unclear whether magnetic resonance imaging improves diagnosis beyond what can be achieved by skilled ultrasound operators. Therefore, any screening programme for PAS will require improved training in the diagnosis of placental disorders and development of targeted scanning protocols. Management strategies for praevia PAS vary depending on the accuracy of prenatal diagnosis, findings at laparotomy and local surgical expertise. Current epidemiological data for PAS are highly heterogeneous, mainly due to wide variation in the clinical criteria used to diagnose the condition at birth. This significantly impacts research into all aspects of the condition, especially comparison of the efficacy of different management strategies.

Keywords: Caesarean hysterectomy; Increta; Percreta; Placenta accreta; Prenatal diagnosis; Ultrasound imaging.

Publication types

  • Review

MeSH terms

  • Cesarean Section
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Placenta Accreta* / diagnostic imaging
  • Placenta Previa* / diagnostic imaging
  • Pregnancy
  • Prenatal Diagnosis