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Placenta Accreta Spectrum
Anne Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Abnormal extension of placental tissue beyond endometrial lining of uterus, traditionally staged on histopathology as accreta/increta/percreta
                • 75-80% placenta accreta: Placenta attached to myometrium without muscular invasion
                • 15% placenta increta: Chorionic villi (CV) invade myometrium
                • 5% placenta percreta: CV penetrate serosa ± extend to involve adjacent bladder, rectum, parametrium
              • Clinical terms include placenta accreta spectrum (PAS), placental adhesive disorders, abnormally invasive placenta

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Fonseca A et al: Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 72:84-91, 2021
                                      2. Piñas-Carrillo A et al: Conservative surgical approach: the triple P procedure. Best Pract Res Clin Obstet Gynaecol. 72:67-74, 2021
                                      3. Sentilhes L et al: Conservative approach: intentional retention of the placenta. Best Pract Res Clin Obstet Gynaecol. 72:52-66, 2021
                                      4. Bartels HC et al: A life changing experience: an interpretative phenomenological analysis of women's experiences of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol. 254:102-8, 2020
                                      5. Carusi DA et al: Placenta accreta spectrum without placenta previa. Obstet Gynecol. 136(3):458-65, 2020
                                      6. Clark HR et al: Placenta accreta spectrum: correlation of MRI parameters with pathologic and surgical outcomes of high-risk pregnancies. AJR Am J Roentgenol. 214(6):1417-23, 2020
                                      7. di Pasquo E et al: Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. Ultrasound Obstet Gynecol. 55(4):460-6, 2020
                                      8. Expert Panel on Women's Imaging. et al: ACR Appropriateness Criteria® placenta accreta spectrum disorder. J Am Coll Radiol. 17(5S):S207-14, 2020
                                      9. Grover B et al: Patient-reported health outcomes and quality of life after peripartum hysterectomy for placenta accreta spectrum. Am J Perinatol. ePub, 2020
                                      10. Happe SK et al: Predicting placenta accreta spectrum: validation of the placenta accreta index. J Ultrasound Med. ePub, 2020
                                      11. Jauniaux E et al: A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accreta. Am J Obstet Gynecol. 222(4):379.e1-11, 2020
                                      12. Jauniaux E et al: Rethinking prenatal screening for anomalies of placental and umbilical cord implantation. Obstet Gynecol. 136(6):1211-16, 2020
                                      13. Jha P et al: Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. Eur Radiol. 30(5):2604-15, 2020
                                      14. Modest AM et al: Placenta accreta spectrum: in vitro fertilization and non-in vitro fertilization and placenta accreta spectrum in a Massachusetts cohort. Am J Perinatol. ePub, 2020
                                      15. Nagase Y et al: In-vitro fertilisation-embryo-transfer complicates the antenatal diagnosis of placenta accreta spectrum using MRI: a retrospective analysis. Clin Radiol. 75(12):927-33, 2020
                                      16. Pinas-Carrillo A et al: Outcomes of the first 50 patients with abnormally invasive placenta managed using the "Triple P Procedure" conservative surgical approach. Int J Gynaecol Obstet. 148(1):65-71, 2020
                                      17. Tinari S et al: Systematic review and meta-analysis of posterior placenta accreta spectrum disorders: risk factors, histopathology and diagnostic accuracy. Ultrasound Obstet Gynecol. ePub, 2020
                                      18. Cali G et al: Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol. 53(6):752-60, 2019
                                      19. Jauniaux E et al: FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 146(1):20-4, 2019
                                      20. Quist-Nelson J et al: The compliance with a patient-safety bundle for management of placenta accreta spectrum†. J Matern Fetal Neonatal Med. 1-7, 2019
                                      21. Collins SL et al: Proposal for standardised ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 47(3):271-5, 2016
                                      22. Gilboa Y et al: A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta. J Ultrasound Med. 34(4):561-7, 2015
                                      23. Silver RM et al: Center of excellence for placenta accreta. Am J Obstet Gynecol. 212(5):561-8, 2015
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Definitions

                                                  • Abnormal extension of placental tissue beyond endometrial lining of uterus, traditionally staged on histopathology as accreta/increta/percreta
                                                    • 75-80% placenta accreta: Placenta attached to myometrium without muscular invasion
                                                    • 15% placenta increta: Chorionic villi (CV) invade myometrium
                                                    • 5% placenta percreta: CV penetrate serosa ± extend to involve adjacent bladder, rectum, parametrium
                                                  • Clinical terms include placenta accreta spectrum (PAS), placental adhesive disorders, abnormally invasive placenta

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Fonseca A et al: Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 72:84-91, 2021
                                                                          2. Piñas-Carrillo A et al: Conservative surgical approach: the triple P procedure. Best Pract Res Clin Obstet Gynaecol. 72:67-74, 2021
                                                                          3. Sentilhes L et al: Conservative approach: intentional retention of the placenta. Best Pract Res Clin Obstet Gynaecol. 72:52-66, 2021
                                                                          4. Bartels HC et al: A life changing experience: an interpretative phenomenological analysis of women's experiences of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol. 254:102-8, 2020
                                                                          5. Carusi DA et al: Placenta accreta spectrum without placenta previa. Obstet Gynecol. 136(3):458-65, 2020
                                                                          6. Clark HR et al: Placenta accreta spectrum: correlation of MRI parameters with pathologic and surgical outcomes of high-risk pregnancies. AJR Am J Roentgenol. 214(6):1417-23, 2020
                                                                          7. di Pasquo E et al: Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. Ultrasound Obstet Gynecol. 55(4):460-6, 2020
                                                                          8. Expert Panel on Women's Imaging. et al: ACR Appropriateness Criteria® placenta accreta spectrum disorder. J Am Coll Radiol. 17(5S):S207-14, 2020
                                                                          9. Grover B et al: Patient-reported health outcomes and quality of life after peripartum hysterectomy for placenta accreta spectrum. Am J Perinatol. ePub, 2020
                                                                          10. Happe SK et al: Predicting placenta accreta spectrum: validation of the placenta accreta index. J Ultrasound Med. ePub, 2020
                                                                          11. Jauniaux E et al: A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accreta. Am J Obstet Gynecol. 222(4):379.e1-11, 2020
                                                                          12. Jauniaux E et al: Rethinking prenatal screening for anomalies of placental and umbilical cord implantation. Obstet Gynecol. 136(6):1211-16, 2020
                                                                          13. Jha P et al: Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. Eur Radiol. 30(5):2604-15, 2020
                                                                          14. Modest AM et al: Placenta accreta spectrum: in vitro fertilization and non-in vitro fertilization and placenta accreta spectrum in a Massachusetts cohort. Am J Perinatol. ePub, 2020
                                                                          15. Nagase Y et al: In-vitro fertilisation-embryo-transfer complicates the antenatal diagnosis of placenta accreta spectrum using MRI: a retrospective analysis. Clin Radiol. 75(12):927-33, 2020
                                                                          16. Pinas-Carrillo A et al: Outcomes of the first 50 patients with abnormally invasive placenta managed using the "Triple P Procedure" conservative surgical approach. Int J Gynaecol Obstet. 148(1):65-71, 2020
                                                                          17. Tinari S et al: Systematic review and meta-analysis of posterior placenta accreta spectrum disorders: risk factors, histopathology and diagnostic accuracy. Ultrasound Obstet Gynecol. ePub, 2020
                                                                          18. Cali G et al: Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol. 53(6):752-60, 2019
                                                                          19. Jauniaux E et al: FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 146(1):20-4, 2019
                                                                          20. Quist-Nelson J et al: The compliance with a patient-safety bundle for management of placenta accreta spectrum†. J Matern Fetal Neonatal Med. 1-7, 2019
                                                                          21. Collins SL et al: Proposal for standardised ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 47(3):271-5, 2016
                                                                          22. Gilboa Y et al: A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta. J Ultrasound Med. 34(4):561-7, 2015
                                                                          23. Silver RM et al: Center of excellence for placenta accreta. Am J Obstet Gynecol. 212(5):561-8, 2015