Cited by 82Maternal and fetal healthcarePregnancy and preeclampsia studiesUterine Myomas and Treatments

Searching for placenta percreta: a prospective cohort and systematic review of case reports

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Jauniaux, Eric, Hecht, Jonathan L., Elbarmelgy, Rasha A., Elbarmelgy, Rana M., Thabet, Mohamed M., Hussein, Ahmed M.·2022·American Journal of Obstetrics and Gynecology

Abstract

Background Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the literature.Objective We investigated the hypothesis that placenta percreta, which has been described clinically as placental tissue invading through the full thickness of the uterus, is a heterogeneous category with most cases owing to primary or secondary uterine abnormality rather than an abnormally invasive form of placentation.Study design We have evaluated the agreement between the intraoperative findings using the International Federation of Gynecology and Obstetrics classification with the postoperative histopathology diagnosis in a prospective cohort of 101 consecutive singleton pregnancies presenting with a low-lying placenta or placenta previa, a history of at least 1 prior cesarean delivery and ultrasound signs suggestive of placenta accreta spectrum. Furthermore, a systematic literature review of case reports of placenta percreta, which included histopathologic findings and gross images, was performed.Results Samples for histologic examination were available in 80 of 101 cases of the cohort, which were managed by hysterectomy or partial myometrial resection. Microscopic examination showed evidence of placenta accreta spectrum in 65 cases (creta, 9; increta, 56). Of 101 cases included in the cohort, 44 (43.5%) and 54 (53.5%) were graded as percreta by observer A and observer B, respectively. There was a moderate agreement between observers. Of note, 11 of 36 cases that showed no evidence of abnormal placental attachment at delivery and/or microscopic examination were classified as percreta by both observers. The systematic literature review identified 41 case reports of placenta percreta with microscopic images and presenting symptomatology, suggesting that most cases were the consequence of a uterine rupture. The microscopic descriptions were heterogeneous, and all descriptions demonstrated histology of placenta creta rather than percreta.Conclusion Our study supported the concept that placenta accreta is not an invasive disorder of placentation but the consequence of postoperative surgical remodeling or a preexisting uterine pathology and found no histologic evidence supporting the existence of a condition where the villous tissue penetrates the entire uterine wall, including the serosa and beyond.

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  1. Morison JE. Placenta accreta. A clinicopathologic review of 67 cases. Obstet Gynecol Annu. 1978;7:107-23.
  2. N Y State J Med. 1983;83:857-66.
  3. Fox H. Pathology of the placenta, second ed., Saunders, London, 1997.

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Authors
Jauniaux, E., Hecht, J. L., Elbarmelgy, R. A., Elbarmelgy, R. M., Thabet, M. M., & Hussein, A. M.
Affiliations
  • University College London (GB)
  • Beth Israel Deaconess Medical Center (US)
  • Cairo University (EG)
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2022-06
Volume
226
Issue
6
Pages
837.e1-837.e13
ISSN
0002-9378 (ISSN-L)
OpenAlex
W4200222356
Cited by
82
References
93
Citations by year
2026: 23 · 2025: 16 · 2024: 13 · 2023: 18 · 2022: 11
FWCI
2.55
Type
journal article
Language
en
Open access
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Keywords
placenta percreta, placenta accreta spectrum, placenta increta, uterine rupture, uterine pathology, low-lying placenta, placenta previa, previous cesarean section, histopathological diagnosis, hysterectomy, observer agreement
MeSH terms
Female, Humans, Placenta, Placenta Accreta, Placenta Previa, Pregnancy, Prospective Studies, Ultrasonography, Prenatal

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