Development Of Placenta Accreta Research Articles

Soluble FMS-Like Tyrosine Kinase-1: Role in placenta accreta spectrum disorder

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sfltsFlt-1 has a role in the development of placenta accreta. Methods: This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Mann-Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05 considered as statistically significant (95%CI). Results: Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. -Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion: sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

Soluble FMS-Like Tyrosine Kinase-1: Role in placenta accreta spectrum disorder.

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sflt sFlt-1 has a role in the development of placenta accreta. Methods:This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Mann-Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05 considered as statistically significant (95%CI). Results:Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. -Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion:sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

Soluble FMS-Like Tyrosine Kinase-1: Role in placenta accreta spectrum disorder

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sfltsFlt-1 has a role in the development of placenta accreta. Methods: This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Mann-Whitney U test, and Kruskal-Wallis analysis test, with a P-value &lt;0.05 considered as statistically significant (95%CI). Results: Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. -Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion: sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

Soluble FMS-Like Tyrosine Kinase-1: Role in placenta accreta spectrum disorder

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sflt sFlt-1 has a role in the development of placenta accreta. Methods: This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Mann-Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05 considered as statistically significant (95%CI). Results: Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. -Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion: sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

Soluble FMS-Like Tyrosine Kinase: Role in placenta accreta spectrum disorder

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sflt-1 has a role in the development of placenta accreta. Methods:This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05 considered as statistically significant (95%CI). Results:Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion:sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

Alcohol Consumption During Pregnancy and Risk of Placental Abnormality: The Japan Environment and Children\u2019s Study

There have been no large nationwide birth cohort studies examining for the effects of maternal alcohol use during pregnancy on placental abnormality. This study searched for associations between alcohol consumption and the placental abnormalities of placenta previa, placental abruption, and placenta accreta using the fixed dataset of a large national birth cohort study commencing in 2011 that included 80,020 mothers with a singleton pregnancy. The presence of placental abnormalities and potential confounding factors were recorded, and multiple logistic regression analysis was employed to search for correlations between maternal alcohol consumption during pregnancy and placental abnormalities. The overall rate of prenatal drinking until the second/third trimester was 2.7% (2,112). The prevalence of placenta previa, placental abruption, and placenta accreta was 0.58% (467), 0.43% (342), and 0.20% (160), respectively. After controlling for potential confounding factors, maternal alcohol use during pregnancy was significantly associated with the development of placenta accreta (OR 3.10, 95%CI 1.69-5.44). In conclusion, this large nationwide survey revealed an association between maternal drinking during pregnancy and placenta accreta, which may lead to excessive bleeding during delivery.

549: Placenta accreta and Intra-abdominal adhesions; the bright side

There is a well-known association between repeated cesarean deliveries (CDs) and the development of placenta accreta (PA). Defective scar decidualization leading to trophoblast invasion is believed to be the culprit for the developmental of accretion. Additionally, repeated CDs may lead to the developmental of severe intra-abdominal adhesions (IAA). Scar decidualization and IAA are both considered tissue healing processes. We aimed to examine the occurrence of IAA among women with PA. Case control study conducted at a single teaching hospital on data from January 2004 to December 2016. The study group included women who underwent a cesarean hysterectomy due to PA and had a pathological confirmation of accretion. The control group was matched for year of birth and number of CDs at a ratio of 1:4. IAA were categorized as “none,” “filmy,” or “dense”. The outcome measures were rate and severity of IAA. We hypothesized that the IAA rate would be lower in cases of defective healing, i.e., in cases of PA. In order to detect a decrease from 50% to 25% in any IAA among the control and the study groups respectively, with alpha (one sided) of 0.05 and 80% power, a sample size of 165 women was needed. Overall, 165 women (33 and 132 in the study and control groups respectively) were included. Except for maternal age, there were no statistically significant differences between the groups in demographic and obstetric variables including maternal diseases, prior abdominal surgeries, and the number of previous CDs. IAA rate was 33.3% and 47.7% in the study and control groups respectively (p=0.04). Rate of dense IAA was 15.2% and 32.6% in the study and control groups respectively (p=0.03). After adjustment for maternal age, there was a significantly lower rate of any IAA (RR=0.39; 95% CI: 0.17-0.93; p=0.02) and dense IAA (RR=0.30; 95% CI: 0.11-0.87; p=0.02) among the study group. The incidence and severity of IAA following CDs are lower among women who develop PA. Decreased wound healing may, at least partly, account for the reduced co-occurrence.

Increased placental trophoblast inclusions in placenta accreta

IntroductionTrophoblast inclusions (TIs) are often found in placentas of genetically abnormal gestations. Although best documented in placentas from molar pregnancies and chromosomal aneuploidy, TIs are also associated with more subtle genetic abnormalities, and possibly autism. Less than 3% of non-aneuploid, non-accreta placentas have TIs. We hypothesize that placental genetics may play a role in the development of placenta accreta and aim to study TIs as a potential surrogate indicator of abnormal placental genetics. MethodsForty cases of placenta accreta in the third trimester were identified in a search of the medical records at one institution. Forty two third trimester control placentas were identified by a review of consecutively received single gestation placentas with no known genetic abnormalities and no diagnosis of placenta accreta. ResultsForty percent of cases with placenta accreta demonstrated TIs compared to 2.4% of controls. More invasive placenta accretas (increta and percreta) were more likely to demonstrate TIs than accreta (47% versus 20%). Prior cesarean delivery was more likely in accreta patients than controls (67% versus 9.5%). DiscussionPlacenta accreta is thought to be the result of damage to the endometrium predisposing to abnormal decidualization and invasive trophoblast growth into the myometrium. However, the etiology of accreta is incompletely understood with accreta frequently occurring in women without predisposing factors and failing to occur in predisposed patients. ConclusionThis study has shown that TIs are present at increased rates in cases of PA. Further studies are needed to discern what underlying pathogenic mechanisms are in common between abnormal placentation and the formation of TIs.

The Risk of Placenta Accreta Following Primary Elective Caesarean Delivery

The rate of abnormal human placentation has risen dramatically, with an increased risk of placenta accreta in older women, women with placenta previa in the present pregnancy, and those with a previous cesarean delivery (CD). This case-control study was performed to determine the association between placenta accreta in a pregnancy complicated by placenta previa and the type of primary CD. Parturients with placenta accreta and placenta previa from 1993 to 2008 were included. Data analysis examined the effects of delivery mode for the primary CD on the development of placenta accreta or its variants in a pregnancy complicated by placenta previa. The primary outcome was the influence of the indication for the primary CD (elective without labor or emergency after some labor) on the subsequent risk of developing placenta accreta. Secondary outcomes were the risk of placenta accreta considering parity, gravidity, uterine surgery before the primary CD, and vaginal delivery before and after the primary CD. Criteria for controls included placenta previa, delivery during the study period, and a history of 1 or more CDs. Statistical analysis was performed using SPSS version 18 for Windows and Logxact 8.1. All tests were 2 sided, and P < 0.05 indicated statistical significance. From 82,667 live births, 88 cases of placenta accreta were identified. The final cohort included 65 women with placenta accreta or variants matched with 101 controls; 67% of cases and 38% of controls delivered at less than 37 weeks’ gestation. Thirty-seven cases (56.9%) had placenta accreta, 15 (23.1%) had placenta increta, and 13 (20.0%) had placenta percreta. Cases and controls differed neither in maternal age, gravidity, or parity nor in other demographic or socioeconomic factors (all P > 0.05). A primary elective CD was performed in 46.2% of the cases and 18.6% of controls (P < 0.001). For women with primary emergency CD, significant differences were noted between cases and controls neither in cervical dilatation or length of labor in the primary labor nor in gestational age or presentation when the primary CD occurred without labor. Compared with women in whom the primary CD occurred after some labor, women whose primary CD occurred without labor were significantly more likely to develop placenta accreta (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.47–6.12; P = 0.025). Gravidity (aOR, 0.79; 95% CI, 0.61–1.03, P = 0.063), parity (aOR, 1.12; 95% CI, 0.75–1.66; P = 0.588), previous vaginal delivery (aOR, 0.85; 95% CI, 0.60–1.21; P = 0.364), and previous uterine surgery (aOR, 1.06; 95% CI, 0.53–2.15; P = 0.866) were not associated with placenta accreta with coexisting placenta previa. Women who undergo a primary CD without labor are 3 times more likely to develop placenta accreta in a subsequent pregnancy complicated by placenta previa than women whose primary CD occurred after labor onset. Clinicians should be aware of this risk when counseling women for whom CD is an option. They should consider limiting the availability of elective CD as a choice to women in whom the alternatives of labor with vaginal delivery or the possibility of an emergency CD pose an unacceptable risk to her and the fetus’s well-being.

Placenta accreta and the risk of adverse maternal and neonatal outcomes

Placenta accreta is an increasingly prevalent and potentially dangerous complication of pregnancy. Although most studies on the subject have addressed the risk factors for the development of this condition, evidence on maternal and neonatal outcomes for these pregnancies is scarce. The objective of the present study is to compile current evidence with regard to risk factors as well as adverse outcomes associated with placenta accreta. We conducted a complete literature review using PubMed, MEDLINE, Cochrane Database Reviews, UptoDate, DocGuide, as well as Google scholar and textbook literature for all articles on placenta accreta, and any one of the following keywords: "risk factors", "maternal outcomes", "neonatal outcomes", "morbidity", and "mortality". Individual case reports were excluded. We reviewed 34 studies conducted between 1977 and 2012. A total number of 508,617 deliveries were studied, with 865 cases of confirmed placenta accreta (average pooled incidence = 1/588). The development of placenta accreta appears to be most strongly predicted by a history of cesarean section, low-lying placenta/previa, in vitro fertilization pregnancy, as well as elevated second-trimester levels of α-fetoprotein and β-human chorionic gonadotropin. The most significant maternal outcomes include the need for postpartum transfusion due to hemorrhage and peripartum hysterectomy. Maternal mortality remains rare but significantly higher than among matched, postpartum controls. Important neonatal outcomes include preterm birth, low birth weight, small for gestational age, and reduced 5-min Apgar scores. Whether the need for neonatal intensive care unit admission and steroid administration is iatrogenic and whether an increased risk of perinatal mortality is a clinically significant and independent outcome remain controversial. Although there is a significant shortage of studies on the subject, it appears that placenta accreta is associated with adverse maternal and neonatal outcomes, some of which may be life threatening. Prenatal diagnosis and adequate planning, particularly in high-risk populations, may be indicated for the reduction of these adverse outcomes.

55: Role of hypoxic pathways in the development of placenta accreta

55: Role of hypoxic pathways in the development of placenta accreta

Differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors in placentas from pregnancies complicated by placenta accreta

The purpose of this study was to investigate the differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors (Tie-1 and Tie-2) in placentas from pregnancies complicated by placenta accreta. Paraffin sections of 46 placental specimens with (cases) and 46 without (controls) placenta accreta were studied immunohistochemically for the expression of Tie receptors and angiopoietin-2 in trophoblast populations. Protein levels of Tie receptors and angiopoietins were also examined by Western blot analysis and/or enzyme-linked immunosorbent assay. Controls were matched for gestational age in this case-control study. In both second and third trimesters, the percentage of intermediate/strong immunoreactivity of Tie-2 in the syncytiotrophoblast was significantly lower in cases than controls (P = .015 and .025, respectively). However, Tie-2 expression in the cytotrophoblastic and extravillous trophoblastic cells and Tie-1 in all trophoblast subpopulations were not significantly different between cases and controls (P > .05). The majority of Tie-2 expression, as demonstrated by Western blots, was consistent with the trends of immunohistochemical findings in the syncytiotrophoblast. Enzyme-linked immunosorbent assay in the placental lysates showed that women with placenta accreta demonstrated significantly higher angiopoietin-2 and lower Tie-2 concentrations than did women with normal pregnancies (P = .026 and .003, respectively). Placental angiopoietin-1 levels did not have any significance (P > .05). Also, angiopoietin-2 immunoreactivity in the syncytiotrophoblast was compatible with the finding demonstrated by enzyme-linked immunosorbent assay (P = .005 and .012, respectively). These observations suggest that the participation of up-regulated angiopoietin-2 and down-regulated Tie-2 in the placental tissues may indicate a role for these angiogenic factors in the development of placenta accreta.

Differential expression of vascular endothelial growth factor, placenta growth factor and their receptors in placentae from pregnancies complicated by placenta accreta

Placenta accreta is a pregnancy complication characterized by the presence of life-threatening uteroplacental neovascularization. The factors involving its development are unknown. Vascular endothelial growth factor (VEGF), placenta growth factor (PlGF) and their receptors (VEGFR) have important roles in vascular remodeling. We have investigated the differential expression of these proteins in placentae from placenta accreta (cases) and normal placentation (controls). Immunohistochemically, the expression of VEGFR-2 in the syncytiotrophoblast was significantly lower in cases than in controls during both the second and third trimesters (P = 0.005 and 0.002, respectively). However, VEGFR-2 expression in the cytotrophoblastic and extravillous trophoblastic cells and VEGFR-1, -3 and Ki-67 in the trophoblast populations were not significantly different between controls and cases (P > 0.05). Ki-67 immunostaining also showed that endothelial cells of the larger vessels were stained weaker in normal placenta than in placenta accreta. The majority of VEGFR-2 expression, as demonstrated by Western blot or reverse transcription polymerase chain reaction, was consistent with the immunohistochemical findings in the syncytiotrophoblast. Furthermore, enzyme-linked immunosorbent assay in the placental lysates showed that the women with placenta accreta demonstrated significantly higher VEGF (P = 0.001) and lower soluble VEGFR-2 (P = 0.015) concentrations than did women with normal pregnancy. PlGF and soluble VEGFR-1 levels did not show any significance in study groups (P > 0.05). These observations suggest that the participation of up-regulated VEGF and down-regulated VEGFR-2 (both membrane-bound and soluble forms) may be associated with the development of placenta accreta.

Expression of epidermal growth factor receptor and c-erbB-2 oncoprotein in trophoblast populations of placenta accreta

The purpose of this study was to investigate the expression of epidermal growth factor receptor and c-erbB-2 oncoprotein in trophoblast populations of placenta accreta. Paraffin sections of 43 placental specimens with (cases) and 43 without (controls) placenta accreta were studied immunohistochemically for epidermal growth factor receptor and c-erbB-2 expression in the syncytiotrophoblast, villous cytotrophoblast, and extravillous cytotrophoblast. Epidermal growth factor receptor and c-erbB-2 protein levels were also performed by Western blot analysis. Controls were matched for gestational age in this case-control study. The percentage of strong/intermediate immunoreactivity of epidermal growth factor receptor in the syncytiotrophoblast was significantly higher in cases (98%) than controls (79%; odds ratio,11.1; 95% CI, 1.3-92.0; P = .03), although strong/intermediate immunoreactivity of c-erbB-2 in the syncytiotrophoblast was significantly lower in cases (35%) than controls (81%; odds ratio, 0.1; 95% CI, 0.1-0.3; P < .001). Epidermal growth factor receptor and c-erbB-2 expression in the villous and extravillous cytotrophoblastic cells were not significantly different between controls and cases ( P > .05). Most immunoreactive bands on Western blots were consistent with the trends of immunohistochemical findings. The development of placenta accreta is related closely to the differential expression of epidermal growth factor receptor and c-erbB-2 in the syncytiotrophoblast.

Human cytotrophoblast cell islands—Morphological characteristics in vitro

The purpose of this study was to investigate the expression of epidermal growth factor receptor and c-erbB-2 oncoprotein in trophoblast populations of placenta accreta.Paraffin sections of 43 placental specimens with (cases) and 43 without (controls) placenta accreta were studied immunohistochemically for epidermal growth factor receptor and c-erbB-2 expression in the syncytiotrophoblast, villous cytotrophoblast, and extravillous cytotrophoblast. Epidermal growth factor receptor and c-erbB-2 protein levels were also performed by Western blot analysis. Controls were matched for gestational age in this case-control study.The percentage of strong/intermediate immunoreactivity of epidermal growth factor receptor in the syncytiotrophoblast was significantly higher in cases (98%) than controls (79%; odds ratio,11.1; 95% CI, 1.3-92.0; P = .03), although strong/intermediate immunoreactivity of c-erbB-2 in the syncytiotrophoblast was significantly lower in cases (35%) than controls (81%; odds ratio, 0.1; 95% CI, 0.1-0.3; P < .001). Epidermal growth factor receptor and c-erbB-2 expression in the villous and extravillous cytotrophoblastic cells were not significantly different between controls and cases (P > .05). Most immunoreactive bands on Western blots were consistent with the trends of immunohistochemical findings.The development of placenta accreta is related closely to the differential expression of epidermal growth factor receptor and c-erbB-2 in the syncytiotrophoblast.

Interferon production in human placental trophoblast subpopulations

Trophoblast inclusions (TIs) are often found in placentas of genetically abnormal gestations. Although best documented in placentas from molar pregnancies and chromosomal aneuploidy, TIs are also associated with more subtle genetic abnormalities, and possibly autism. Less than 3% of non-aneuploid, non-accreta placentas have TIs. We hypothesize that placental genetics may play a role in the development of placenta accreta and aim to study TIs as a potential surrogate indicator of abnormal placental genetics.Forty cases of placenta accreta in the third trimester were identified in a search of the medical records at one institution. Forty two third trimester control placentas were identified by a review of consecutively received single gestation placentas with no known genetic abnormalities and no diagnosis of placenta accreta.Forty percent of cases with placenta accreta demonstrated TIs compared to 2.4% of controls. More invasive placenta accretas (increta and percreta) were more likely to demonstrate TIs than accreta (47% versus 20%). Prior cesarean delivery was more likely in accreta patients than controls (67% versus 9.5%).Placenta accreta is thought to be the result of damage to the endometrium predisposing to abnormal decidualization and invasive trophoblast growth into the myometrium. However, the etiology of accreta is incompletely understood with accreta frequently occurring in women without predisposing factors and failing to occur in predisposed patients.This study has shown that TIs are present at increased rates in cases of PA. Further studies are needed to discern what underlying pathogenic mechanisms are in common between abnormal placentation and the formation of TIs.