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Cited by 100Maternal and fetal healthcareUterine Myomas and TreatmentsPregnancy and preeclampsia studies

Placenta accreta spectrum

Open access
Einerson, Brett D., Gilner, Jennifer B., Zuckerwise, Lisa C.·2023·Obstetrics & Gynecology
DOI 10.1097/aog.0000000000005229PMC PMC10491415
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Abstract

Placenta accreta spectrum (PAS) is one of the most dangerous conditions in pregnancy and is increasing in frequency. The risk of life-threatening bleeding is present throughout pregnancy but is particularly high at the time of delivery. Although the exact cause is unknown, the result is clear: Severe PAS distorts the uterus and surrounding anatomy and transforms the pelvis into an extremely high-flow vascular state. Screening for risk factors and assessing placental location by antenatal ultrasonography are essential for timely diagnosis. Further evaluation and confirmation of PAS are best performed in referral centers with expertise in antenatal imaging and surgical management of PAS. In the United States, cesarean hysterectomy with the placenta left in situ after delivery of the fetus is the most common treatment for PAS, but even in experienced referral centers, this treatment is often morbid, resulting in prolonged surgery, intraoperative injury to the urinary tract, blood transfusion, and admission to the intensive care unit. Postsurgical complications include high rates of posttraumatic stress disorder, pelvic pain, decreased quality of life, and depression. Team-based, patient-centered, evidence-based care from diagnosis to full recovery is needed to optimally manage this potentially deadly disorder. In a field that has relied mainly on expert opinion, more research is needed to explore alternative treatments and adjunctive surgical approaches to reduce blood loss and postoperative complications.

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Registry

Crossref · 10.1097/aog.0000000000005229

Cites

114 of 114 references verified0 citation errors · 0 not checkable

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  • MRI is typically used when ultrasound results are inconclusive, offering superior soft tissue contrast and clearer visualization of placental invasion depth and extent.

    “MRI is typically used when ultrasound results are inconclusive, offering superior soft tissue contrast and clearer visualization of placental invasion depth and extent [3].”

    From Machine Learning in Maternity: Early Diagnosis of Placenta Accreta Spectrum (2026) · cites this paper as [3]

    The Magnetic Resonance Imaging section says MRI may add information about disease character or location beyond ultrasound in select cases. It does not say MRI is typically used after inconclusive ultrasound, or that superior soft-tissue contrast provides clearer visualization of invasion depth and extent; it cautions that MRI is not a helpful adjunct in every setting. No page number is available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Ultrasound is the first-line diagnostic tool for PAS due to its wide availability, non-invasiveness, and cost-effectiveness.

    “PAS is traditionally diagnosed prenatally using imaging modalities such as ultrasound and MRI, with ultrasound being the first-line diagnostic tool due to its wide availability, non-invasiveness, and cost-effectiveness [3,7].”

    From Machine Learning in Maternity: Early Diagnosis of Placenta Accreta Spectrum (2026) · cites this paper as [3]

    The Ultrasound section calls ultrasound the primary screening and diagnostic modality for patients at risk of PAS. The Diagnosis section says MRI’s routine use is limited by higher cost and limited availability of interpretive expertise, supporting the comparison with ultrasound. Our copy does not give non-invasiveness as a reason for using ultrasound first. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 1

  1. Benirschke K, Burton GJ, Baergen R. Pathology of the human placenta (6th ed.). 6 ed. New York: Springer 2012.

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Related

Authors
Einerson, B. D., Gilner, J. B., & Zuckerwise, L. C.
Affiliations
Duke University (US)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-06-07
Volume
142
Issue
1
Pages
31-50
ISSN
  • 0029-7844 (ISSN-L)
  • 1873-233X
DOI
10.1097/aog.0000000000005229
PMC
PMC10491415
OpenAlex
W4379779807
Cited by
100
References
114
Citations by year
2026: 31 · 2025: 43 · 2024: 22 · 2023: 4
FWCI
36.67
Type
journal article
Language
en
Update notices
correction (2024-11-01)
Open access
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Child Health and Human Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD106009)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords
placenta accreta spectrum, placental abruption, antenatal ultrasonography, cesarean hysterectomy, postoperative complications, post-traumatic stress disorder, pelvic pain, risk factors, obstetric hemorrhage, surgical management
MeSH terms
Cesarean Section, Female, Humans, Placenta, Placenta Accreta, Pregnancy, Quality of Life, United States, Ultrasonography, Prenatal

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