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Cited by 481Maternal and fetal healthcareBlood transfusion and managementUterine Myomas and Treatments

Placenta accreta spectrum

Open access
Cahill, Alison G., Beigi, Richard, Heine, R. Phillips, Silver, Robert M., Wax, Joseph R.·2018·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2018.09.042
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Abstract

Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. The most favored hypothesis regarding the etiology of placenta accreta spectrum is that a defect of the endometrial-myometrial interface leads to a failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of placenta accreta spectrum; thus, clinical risk factors remain equally important as predictors of placenta accreta spectrum by ultrasound findings. There are several risk factors for placenta accreta spectrum. The most common is a previous cesarean delivery, with the incidence of placenta accreta spectrum increasing with the number of prior cesarean deliveries. Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus (attempts at placental removal are associated with significant risk of hemorrhage). Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location.

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  • ML, with its ability to read complex imaging data and reduce dependence on operator skill, has great potential as a method of improving consistency and enabling earlier diagnosis of PAS.

    “ML, with its ability to read complex imaging data [17] and to reduce the dependence on operator skill, has great potential as a method of improving consistency and enabling earlier diagnosis of PAS [6].”

    From Machine Learning in Maternity: Early Diagnosis of Placenta Accreta Spectrum (2026) · cites this paper as [6]

    The Obstetric Care Consensus section reports substantial variation between ultrasound readers and a need to standardize findings. The Diagnosis of Placenta Accreta Spectrum section says antenatal diagnosis is desirable and that ultrasound features can appear in the first trimester. The paper does not assess machine learning or say it can reduce operator dependence, improve consistency, or enable earlier diagnosis. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. Zosmer N, Fuller J, Shaikh H, Johns J, Ross JA. Natural history of early first-trimester pregnancies implanted in Cesarean scars. Ultrasound Obstet Gynecol 2015;46:367-75.

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Authors
Cahill, A. G., Beigi, R., Heine, R. P., Silver, R. M., & Wax, J. R.
Affiliations
Society for Maternal-Fetal Medicine (US)
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2018-12
Volume
219
Issue
6
Pages
B2-B16
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2018.09.042
OpenAlex
W2901857044
Cited by
481
References
99
Citations by year
2026: 34 · 2025: 76 · 2024: 82 · 2023: 85 · 2022: 62 · 2021: 70 · 2020: 42 · 2019: 25 · 2017: 1 · 2016: 1 · 2014: 1
FWCI
38.07
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Keywords
placenta accreta spectrum, placenta increta, placenta percreta, placenta accreta, decidualization, uterine scar, cesarean section, postpartum hemorrhage, prenatal diagnosis, cesarean hysterectomy, placental retention, risk factors, multidisciplinary care, massive transfusion
MeSH terms
Cesarean Section, Female, Gynecology, Humans, Hysterectomy, Obstetrics, Placenta Accreta, Pregnancy, Prenatal Diagnosis, Societies, Medical, United States

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