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Am J Perinatol 2023; 40(09): 996-1001
DOI: 10.1055/s-0043-1761639
PAS Series Article
Review Article

The Need for Presurgical Evaluation for Placenta Accreta Spectrum

Authors

  • Brett D. Einerson

    1   University of Utah Health, Salt Lake City, Utah

  • Alireza A. Shamshirsaz

    Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts
    Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts

  • Megan L. Stephenson

    Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Kaiser Permanente, Santa Clara, California

  • Meena Khandelwal

    Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey

  • Roxane Holt

    Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois

  • Christina M. Duzyj

    Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts
    Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, Massachusetts

  • Vineet K. Shrivastava

    MemorialCare Miller Children's & Women's Hospital, Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Long Beach, California
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Abstract

Staging or grading of placenta accreta spectrum has historically relied on histopathologic evaluation of placental and uterine specimens. This approach has limited utility, since it is retrospective in nature and does not allow for presurgical planning. Here, we argue for a paradigm shift to use of clinical and imaging characteristics to define the presurgical stage. We summarize past attempts at staging, and define a new data-driven approach to determining the stage prior to delivery. Use of this model may help hospitals direct patients to the most appropriate level of care for workup and management of placenta accreta spectrum.

Key Points

  • Staging systems that rely on histopathologic grade (accreta, increta, percreta) are unhelpful in antenatal planning for placenta accreta spectrum.

  • Past attempts at pre-delivery (pre-surgical) staging have failed to account for key factors that contribute to risk and morbidity.

  • We developed a data-driven model that could be easily incorporated as a decision aid into clinical practice to help clinicians decide an individual patient's risk for placenta accreta spectrum.

Keywords

prenatal ultrasound - risk assessment - hemorrhage - levels of maternal care - hysterectomy


Publication History

Article published online:
19 June 2023

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