Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(05): 347-350
DOI: 10.1055/s-0041-1731301
Editorial

Placenta Accreta Spectrum Disorders and Cesarean Scar Pregnancy Screening: Are we Asking the Right Questions?

Conrado Milani Coutinho 
1   Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
,
Laure Noel 
2   Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
,
Veronica Giorgione 
3   Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
,
Lígia Conceição Assef Marçal 
1   Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
,
Amar Bhide 
2   Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
,
Basky Thilaganathan 
2   Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
3   Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
› Author Affiliations
› Further Information
   Permissions and Reprints

According to the World Health Organization, approximately 295,000 women died in 2017 during the antenatal and postpartum period. The vast majority (94%) of these cases occurred in low- and middle-income countries, with an estimate of 810 daily deaths from preventable causes.[1] Obstetric hemorrhage is the leading cause of maternal mortality worldwide and, among its key etiologies, placenta accreta spectrum (PAS) disorders have been increasing in prevalence concurrently with the global rise in the proportion of Cesarean deliveries and rates have currently being reported between 0.01% to 1.1% of pregnancies.[2] [3] [4] [5] Accurate screening and diagnosis of PAS is of utmost importance for timely antenatal referral to tertiary hospitals and management by specialized multidisciplinary teams, which has been associated with a reduction in its associated morbimortality.[6] Although ultrasound diagnosis of PAS can be reliably done in centers with expertise, with an accuracy of approximately 90%,[7] [8] in non-specialized facilities this rate falls to 50%, mainly due to insufficient clinical suspicion and/or knowledge of risk factors.[9] [10] Therefore, effective and systematic screening and diagnostic protocols for PAS should be implemented in all maternal-fetal health care services in order to prevent adverse outcomes related to undiagnosed PAS disorders. The purpose of this article is to highlight the importance of basic questions that should be incorporated by all sonographers while performing routine obstetrical ultrasound to improve the detection of PAS.



Publication History

Article published online:
28 June 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division [Internet]. Geneva: World Health Organization; 2019 [cited 2020 Dec 15]. Available from: https://www.who.int/reproductivehealth/publications/maternal-mortality-2000-2017/en/
    PubMedSearch in Google Scholar
  • 2 Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221 (03) 208-218
    CrossrefPubMedSearch in Google Scholar
  • 3 Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM. et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand 2013; 92 (04) 457-460
    CrossrefPubMedSearch in Google Scholar
  • 4 Higgins MF, Monteith C, Foley M, O'Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section. Eur J Obstet Gynecol Reprod Biol 2013; 171 (01) 54-56
    CrossrefPubMedSearch in Google Scholar
  • 5 Cheng KK, Lee MM. Rising incidence of morbidly adherent placenta and its association with previous caesarean section: a 15-year analysis in a tertiary hospital in Hong Kong. Hong Kong Med J 2015; 21 (06) 511-517
    CrossrefPubMedSearch in Google Scholar
  • 6 Buca D, Liberati M, Calì G, Forlani F, Caisutti C, Flacco ME. et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52 (03) 304-309
    CrossrefPubMedSearch in Google Scholar
  • 7 Pagani G, Cali G, Acharya G, Trisch IT, Palacios-Jaraquemada J, Familiari A. et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97 (01) 25-37
    CrossrefPubMedSearch in Google Scholar
  • 8 Melcer Y, Jauniaux E, Maymon S, Tsviban A, Pekar-Zlotin M, Betser M. et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol 2018; 218 (04) 443.e1-443.e8
    CrossrefPubMedSearch in Google Scholar
  • 9 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121 (01) 62-70 , discussion 70–71
    CrossrefPubMedSearch in Google Scholar
  • 10 Bowman ZS, Eller AG, Kennedy AM, Richards DS, Winter 3rd TC, Woodward PJ. et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211 (02) 177.e1-177.e7
    CrossrefPubMedSearch in Google Scholar
  • 11 Iacovelli A, Liberati M, Khalil A, Timor-Trisch I, Leombroni M, Buca D. et al. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 33 (03) 471-481
    CrossrefPubMedSearch in Google Scholar
  • 12 De Mucio B, Serruya S, Alemán A, Castellano G, Sosa CG. A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. Int J Gynaecol Obstet 2019; 147 (03) 281-291
    CrossrefPubMedSearch in Google Scholar
  • 13 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7 (12) e52893
    CrossrefPubMedSearch in Google Scholar
  • 14 Garmi G, Goldman S, Shalev E, Salim R. The effects of decidual injury on the invasion potential of trophoblastic cells. Obstet Gynecol 2011; 117 (01) 55-59
    CrossrefPubMedSearch in Google Scholar
  • 15 Sholapurkar SL. Increased incidence of placenta praevia and accreta with previous caesareans--a hypothesis for causation. J Obstet Gynaecol 2013; 33 (08) 806-809
    CrossrefPubMedSearch in Google Scholar
  • 16 Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008; 29 (07) 639-645
    CrossrefPubMedSearch in Google Scholar
  • 17 Einerson BD, Comstock J, Silver RM, Branch DW, Woodward PJ, Kennedy A. Placenta accreta spectrum disorder: uterine dehiscence, not placental invasion. Obstet Gynecol 2020; 135 (05) 1104-1111
    CrossrefPubMedSearch in Google Scholar
  • 18 Kamel R, Thilaganathan B. Time to reconsider elective Cesarean birth. Ultrasound Obstet Gynecol 2021; 57 (03) 363-365
    CrossrefPubMedSearch in Google Scholar
  • 19 Kamara M, Henderson JJ, Doherty DA, Dickinson JE, Pennell CE. The risk of placenta accreta following primary elective caesarean delivery: a case-control study. BJOG 2013; 120 (07) 879-886
    CrossrefPubMedSearch in Google Scholar
  • 20 Shi XM, Wang Y, Zhang Y, Wei Y, Chen L, Zhao YY. Effect of primary elective cesarean delivery on placenta accreta: a case-control study. Chin Med J (Engl) 2018; 131 (06) 672-676
    CrossrefPubMedSearch in Google Scholar
  • 21 Kamel R, Eissa T, Sharaf M, Negm S, Thilaganathan B. Position and integrity of uterine scar are determined by degree of cervical dilatation at time of Cesarean section. Ultrasound Obstet Gynecol 2021; 57 (03) 466-470
    CrossrefPubMedSearch in Google Scholar
  • 22 D'Antonio F, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F. et al. First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51 (02) 176-183
    CrossrefPubMedSearch in Google Scholar
  • 23 Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019; 53 (01) 101-106
    CrossrefPubMedSearch in Google Scholar
  • 24 Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteaugudo A, Buca D, Forlani F. et al. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51 (02) 169-175
    CrossrefPubMedSearch in Google Scholar
  • 25 Kaelin Agten A, Cali G, Monteagudo A, Oviedo J, Ramos J, Timor-Tritsch I. The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche”. Am J Obstet Gynecol 2017; 216 (05) 510.e1-510.e6
    CrossrefPubMedSearch in Google Scholar
  • 26 Calí G, Timor-Tritsch IE, Forlani F, Palacios-Jaraquemada J, Monteagudo A, Agten AK. et al. Value of first-trimester ultrasound in prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome. Ultrasound Obstet Gynecol 2020; 55 (04) 450-459
    CrossrefPubMedSearch in Google Scholar
  • 27 Coutinho CM, Giorgione V, Noel L, Liu B, Chandraharan E, Pryce J. et al. Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low-lying placenta and previous uterine surgery. Ultrasound Obstet Gynecol 2021; 57 (01) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 28 Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146 (01) 20-24
    CrossrefPubMedSearch in Google Scholar
  • 29 Chandraharan E, Hartopp R, Thilaganathan B, Coutinho CM. How to set up a regional specialist referral service for Placenta Accreta Spectrum (PAS) disorders?. Best Pract Res Clin Obstet Gynaecol 2021; 72: 92-101
    CrossrefPubMedSearch in Google Scholar