Placenta accreta spectrum in pregnancy?
Placenta accreta spectrum (PAS) refers to a group of conditions in pregnancy where the placenta abnormally attaches to the uterine wall. This abnormal attachment can lead to significant complications during pregnancy and childbirth. PAS encompasses several related conditions, including:
- Placenta Accreta: In placenta accreta, the placenta attaches too deeply into the uterine wall, often penetrating through the uterine lining (endometrium) and into the myometrium (muscle layer of the uterus). This condition occurs when the placenta fails to separate properly after delivery.
- Placenta Increta: Placenta increta occurs when the placenta invades even deeper into the myometrium than in placenta accreta. The placental tissue penetrates into the muscle layer of the uterus, making separation even more difficult.
- Placenta Percreta: Placenta percreta is the most severe form of PAS. In this condition, the placental tissue not only invades the myometrium but may also penetrate through the uterine wall, sometimes reaching nearby organs such as the bladder or rectum. This can lead to life-threatening hemorrhage during delivery and often requires extensive surgical intervention.
Risk factors for PAS include previous cesarean deliveries, uterine surgeries (such as myomectomy), advanced maternal age, multiparity (having had multiple pregnancies), and placenta previa (where the placenta partially or completely covers the cervix).
Diagnosis of PAS often involves prenatal imaging studies such as ultrasound or magnetic resonance imaging (MRI), which can help identify abnormalities in placental attachment and assess the degree of invasion. However, definitive diagnosis may only be possible during or after delivery.
Management of PAS typically involves a multidisciplinary approach, including obstetricians, maternal-fetal medicine specialists, and sometimes interventional radiologists or urologists. Treatment may involve careful planning for delivery, often with the aim of minimizing blood loss and preserving fertility while ensuring the safety of both the mother and baby. In severe cases, hysterectomy (removal of the uterus) may be necessary to control bleeding and prevent complications.