ABNORMALLY INVASIVE PLACENTA: A LITERATURE REVIEW ON RISK FACTORS, DIAGNOSTIC CHALLENGES, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT

Keywords: Placenta Accreta, Prenatal Diagnosis, Risk Factors, Pathophysiology, Ultrasonography, Prenatal, Postpartum Hemorrhage

Abstract

Placenta accreta spectrum (PAS) is a term used to describe a pathological condition characterised by abnormal placental adherence or invasion of the myometrium or extrauterine structures (1). The condition is characterised by adhesion to the myometrium in the presence of placenta accreta, invasion of the myometrium by placenta increta, and extension of the placenta through the serosa into adjacent organs, a condition known as placenta percreta(1–4) Placenta accreta spectrum disorders (PASDs) are a group of conditions characterised by the excessive adherence of the placenta, which results in the failure of the placenta to separate during birth.

It is widely acknowledged that PASD represents one of the most dangerous conditions associated with pregnancy. In a considerable number of cases, the condition remains undiagnosed prior to delivery. Achieving correct prenatal diagnosis is imperative in order to reduce the burden of maternal and fetal morbidity. Despite the fact that ultrasound remains the imaging modality of choice, magnetic resonance imaging (MRI) is necessary for the evaluation of areas which are difficult to visualise using ultrasound, as well as for the assessment of the extent of placenta accreta (1,2,5,6).

The implementation of effective management strategies is paramount in achieving optimal outcomes. A multidisciplinary approach is required, in addition to the establishment of adequate infrastructure (1). This article defines the characteristics, risk factors, diagnosis, management and outcomes of placenta accreta spectrum, highlighting a multidisciplinary approach.

References

Markfeld Erol, F., Häußler, J. A., Medl, M., Juhasz-Boess, I., & Kunze, M. (2024). Placenta Accreta Spectrum (PAS): Diagnosis, Clinical Presentation, Therapeutic Approaches, and Clinical Outcomes. Medicina (Kaunas, Lithuania), 60(7), 1180. https://doi.org/10.3390/medicina60071180

Srisajjakul, S., Prapaisilp, P., & Bangchokdee, S. (2021). Magnetic Resonance Imaging of Placenta Accreta Spectrum: A Step-by-Step Approach. Korean journal of radiology, 22(2), 198–212. https://doi.org/10.3348/kjr.2020.0580

Hecht, J. L., Baergen, R., Ernst, L. M., Katzman, P. J., Jacques, S. M., Jauniaux, E., Khong, T. Y., Metlay, L. A., Poder, L., Qureshi, F., Rabban, J. T., 3rd, Roberts, D. J., Shainker, S., & Heller, D. S. (2020). Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 33(12), 2382–2396. https://doi.org/10.1038/s41379-020-0569-1

Lucidi, A., Jauniaux, E., Hussein, A. M., Coutinho, C. M., Tinari, S., Khalil, A., Shamshirsaz, A., Palacios-Jaraquemada, J. M., & D'Antonio, F. (2023). Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 62(5), 633–643. https://doi.org/10.1002/uog.26299

Sanders, T. K., & Stewart, J. K. (2023). Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management. Seminars in interventional radiology, 40(4), 349–356. https://doi.org/10.1055/s-0043-1771038

Faralli, I., Del Negro, V., Chinè, A., Aleksa, N., Ciminello, E., & Piccioni, M. G. (2022). Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging. Diagnostics (Basel, Switzerland), 12(11), 2769. https://doi.org/10.3390/diagnostics12112769

Dar, P., & Doulaveris, G. (2024). First-trimester screening for placenta accreta spectrum. American journal of obstetrics & gynecology MFM, 6(5), 101329. https://doi.org/10.1016/j.ajogmf.2024.101329

Bhide A. (2023). Routine screening for placenta accreta spectrum. Best practice & research. Clinical obstetrics & gynaecology, 90, 102392. https://doi.org/10.1016/j.bpobgyn.2023.102392

Afshar, Y., Yin, O., Jeong, A., Martinez, G., Kim, J., Ma, F., Jang, C., Tabatabaei, S., You, S., Tseng, H. R., Zhu, Y., & Krakow, D. (2024). Placenta accreta spectrum disorder at single-cell resolution: a loss of boundary limits in the decidua and endothelium. American journal of obstetrics and gynecology, 230(4), 443.e1–443.e18. https://doi.org/10.1016/j.ajog.2023.10.001

Reale, S. C., & Farber, M. K. (2022). Management of patients with suspected placenta accreta spectrum. BJA education, 22(2), 43–51. https://doi.org/10.1016/j.bjae.2021.10.002

Jenabi, E., Najafi-Vosough, R., & Nazari, A. (2024). Obesity and risk of placenta accreta spectrum: A meta-analysis. Open medicine (Warsaw, Poland), 19(1), 20241047. https://doi.org/10.1515/med-2024-1047

Pegu, B., Thiagaraju, C., Nayak, D., & Subbaiah, M. (2021). Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstetrics & gynecology science, 64(3), 239–247. https://doi.org/10.5468/ogs.20345

Alves, Á. L. L., Silva, L. B. D., Costa, F. D. S., & Rezende, G. C. (2021). Management of placenta accreta spectrum. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 43(9), 713–723. https://doi.org/10.1055/s-0041-1736371

Huang, J., Zhang, X., Liu, L., Duan, S., Pei, C., Zhao, Y., Liu, R., Wang, W., Jian, Y., Liu, Y., Liu, H., Wu, X., & Zhang, W. (2021). Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control. Frontiers in medicine, 8, 557678. https://doi.org/10.3389/fmed.2021.557678

Ma, Y., Hu, Y., & Ma, J. (2023). Animal models of the placenta accreta spectrum: current status and further perspectives. Frontiers in endocrinology, 14, 1118168. https://doi.org/10.3389/fendo.2023.1118168

McLaughlin, H. D., Benson, A. E., Scaglione, M. A., Saviers-Steiger, J. S., Canfield, D. R., Debbink, M. P., Silver, R. M., & Einerson, B. D. (2022). Association between short interpregnancy interval and placenta accreta spectrum. AJOG global reports, 2(2), 100051. https://doi.org/10.1016/j.xagr.2022.100051

Illsley, N. P., DaSilva-Arnold, S. C., Zamudio, S., Alvarez, M., & Al-Khan, A. (2020). Trophoblast invasion: Lessons from abnormally invasive placenta (placenta accreta). Placenta, 102, 61–66. https://doi.org/10.1016/j.placenta.2020.01.004

Liu, X., Wang, Y., Wu, Y., Zeng, J., Yuan, X., Tong, C., & Qi, H. (2021). What we know about placenta accreta spectrum (PAS). European journal of obstetrics, gynecology, and reproductive biology, 259, 81–89. https://doi.org/10.1016/j.ejogrb.2021.02.001

Einerson, B. D., Gilner, J. B., & Zuckerwise, L. C. (2023). Placenta Accreta Spectrum. Obstetrics and gynecology, 142(1), 31–50. https://doi.org/10.1097/AOG.0000000000005229

Bartels, H. C., Walsh, J. M., O'Connor, C., McParland, P., Carroll, S., Higgins, S., Mulligan, K. M., Downey, P., Brophy, D., Colleran, G., Thompson, C., Walsh, T., O'Brien, D. J., Brennan, D. J., McVey, R., McAuliffe, F. M., Donnelly, J., & Corcoran, S. M. (2023). Placenta accreta spectrum ultrasound stage and fetal growth. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 160(3), 955–961. https://doi.org/10.1002/ijgo.14399

Zhang, T., & Wang, S. (2022). Potential Serum Biomarkers in Prenatal Diagnosis of Placenta Accreta Spectrum. Frontiers in medicine, 9, 860186. https://doi.org/10.3389/fmed.2022.860186

Einerson B. D. (2023). Conservative management for placenta accreta spectrum: questions and barriers remain but are surmountable. American journal of obstetrics & gynecology MFM, 5(3), 100859. https://doi.org/10.1016/j.ajogmf.2023.100859

Matsubara S. (2023). Surgery for placenta accreta spectrum: Suggestions for saving maternal lives. Taiwanese journal of obstetrics & gynecology, 62(4), 617–618. https://doi.org/10.1016/j.tjog.2022.04.013

Touhami, O., Allen, L., Flores Mendoza, H., Murphy, M. A., & Hobson, S. R. (2022). Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 32(6), 788–798. https://doi.org/10.1136/ijgc-2021-003325

Durukan, H., Durukan, Ö. B., & Yazıcı, F. G. (2021). Placenta accreta spectrum disorder: a comparison between fertility-sparing techniques and hysterectomy. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 41(3), 353–359. https://doi.org/10.1080/01443615.2020.1755629

Nieto-Calvache, A. J., Sanín-Blair, J. E., Buitrago, M., Maya, J., Benavides, J. A., & Colombian Consensus of Placenta Accreta Spectrum Development Group (2023). Placenta accreta spectrum: treatment consensus in a resource-limited setting. AJOG global reports, 3(3), 100188. https://doi.org/10.1016/j.xagr.2023.100188

Aryananda, R. A., Nieto-Calvache, A. J., Duvekot, J. J., Aditiawarman, A., & Rijken, M. J. (2023). Management of unexpected placenta accreta spectrum cases in resource-poor settings. AJOG global reports, 3(2), 100191. https://doi.org/10.1016/j.xagr.2023.100191

Horng, H. C., Lai, M. J., Chang, W. H., & Wang, P. H. (2021). Placenta accreta spectrum (PAS) and peripartum hysterectomy. Taiwanese journal of obstetrics & gynecology, 60(3), 395–396. https://doi.org/10.1016/j.tjog.2021.03.001

Enste, R., Cricchio, P., Dewandre, P. Y., Braun, T., Leonards, C. O., Niggemann, P., Spies, C., Henrich, W., & Kaufner, L. (2022). Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature. Journal of perinatal medicine, 51(4), 455–467. https://doi.org/10.1515/jpm-2022-0233

Sugai, S., Yamawaki, K., Sekizuka, T., Haino, K., Yoshihara, K., & Nishijima, K. (2023). Pathologically diagnosed placenta accreta spectrum without placenta previa: a systematic review and meta-analysis. American journal of obstetrics & gynecology MFM, 5(8), 101027. https://doi.org/10.1016/j.ajogmf.2023.101027

Views:

14

Downloads:

5

Published
2025-09-08
Citations
How to Cite
Julia Stępień, Weronika Stachera, Maciej Sobczyk, Małgorzata Zach, Wiktoria Suchcicka, Aleksandra Borowy, Aleksandra Chajnowska, Julia Guzowska, Barbara Wołoszyn, & Patrycja Rzeźnik. (2025). ABNORMALLY INVASIVE PLACENTA: A LITERATURE REVIEW ON RISK FACTORS, DIAGNOSTIC CHALLENGES, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT. International Journal of Innovative Technologies in Social Science, 1(3(47). https://doi.org/10.31435/ijitss.3(47).2025.3872

Most read articles by the same author(s)