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

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Placenta Accreta Spectrum

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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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Authors: Cahill, A. G., Beigi, R., Heine, R. P., Silver, R. M., & Wax, J. R.
Affiliations: Society for Maternal-Fetal Medicine (US)
ORCID: Cahill, Alison G.
Beigi, Richard
Heine, R. Phillips
Silver, Robert M.
Wax, Joseph R.
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
FWCI: 38.07
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Hematology › 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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