Placenta Accreta Spectrum: We Can Do Better

Abstract

(Aust N Z J Obstet Gynaecol. 2022;62:376–382) Placenta accreta spectrum (PAS) describes the range of placental disorders. Based on classifications by the International Federation for Gynecology and Obstetrics, Grade 1 PAS indicates an abnormal adherent placenta (accreta), Grade 2 PAS indicates an abnormal invasive placenta into the uterine muscle (increta), and Grade 3 PAS indicates an abnormal placenta that grows into the uterine wall and surrounding organs (percreta). Risk factors for PAS include increased maternal age, multiparity, previous cesarean delivery (CD) or uterine surgery, in vitro fertilization, and placenta previa. The incidence of PAS has been increasing from 0.4 per 1000 births in earlier studies to as high as 3.7 per 1000 births—a trend largely attributed to the worldwide increase in CD. Because PAS is associated with a number of severe pregnancy complications, such as maternal hemorrhage, hysterectomy, and mortality, its accurate diagnosis is important for the appropriate transfer of care and multidisciplinary team (MDT) management. The aim of this study was to determine the rate of antenatal detection of PAS and the impact of MDT management on pregnancy outcomes.