PAS

Q: 38 years old G5P2 female at 36 weeks of pregnancy is admitted to the ICU for high-risk delivery. She was found to have a placenta growing through the uterine wall and invading the urinary bladder. By definition, she has? - select one

A) Placenta accreta

B) Placenta increta 

C) Placenta percreta 

Answer: C

Although Placenta Accreta Spectrum (PAS) is an umbrella term for an abnormal trophoblast adherence to or into the myometrium, scar tissue, and sometimes to or beyond the serosa. At delivery, the placenta may not spontaneously separate, and iatrogenic removal may cause massive hemorrhage, which may require emergent hysterectomy. The highest risk factor for PAS is a placenta previa after a prior cesarean birth.

PAS has three grades:

• Placenta accreta  – Anchoring placental villi attach to the myometrium (rather than decidua)
• Placenta increta – Anchoring placental villi penetrate into the myometrium
• Placenta percreta – Anchoring placental villi penetrate through the myometrium to the uterine serosa or adjacent organ

#ob-gyn

References:

1. Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146:20.

2. Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine; Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018 Dec;219(6):B2-B16. doi: 10.1016/j.ajog.2018.09.042. PMID: 30471891.

3. O'Connor D, Berndl A. Placenta percreta. CMAJ. 2018 Feb 12;190(6):E168. doi: 10.1503/cmaj.171411. PMID: 29440338; PMCID: PMC5809218.