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Am J Perinatol 2023; 40(09): 962-969
DOI: 10.1055/s-0043-1761635
PAS Series Article
Clinical Opinion

Knowledge Gaps in Placenta Accreta Spectrum

Daniela A. Carusi
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Christina M. Duzyj
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Jonathan L. Hecht
3   Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Alexander J. Butwick
4   Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
,
Jon Barrett
5   Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
,
Roxane Holt
6   Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
,
Susan E. O'Rinn
7   Sunnybrook Research Institute, Toronto, Ontario, Canada
,
Yalda Afshar
8   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
,
Jennifer B. Gilner
9   Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
,
J. M. Newton
10   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
,
Scott A. Shainker
11   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
for the Pan-American Society for the Placenta Accreta Spectrum› Author Affiliations
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Abstract

Since its first description early in the 20th Century, placenta accreta and its variants have changed substantially in incidence, risk factor profile, clinical presentation, diagnosis and management. While systematic use of diagnostic tools and a multidisciplinary team care approach has begun to improve patient outcomes, the condition's pathophysiology, epidemiology, and best practices for diagnosis and management remain poorly understood. The use of large databases with broadly accepted terminology and diagnostic criteria should accelerate research in this area. Future work should focus on non-traditional phenotypes, such as those without placenta previa–preventive strategies, and long term medical and emotional support for patients facing this diagnosis.

Key Points

  • Placenta accreta spectrum research may be improved with standardized terminology and use of large databases.

  • Placenta accreta prediction should move beyond ultrasound with the addition of biomarkers, and needs to extend to those without traditional risk factors.

  • Future research should identify practices that can prevent future accreta development.

Keywords

placenta accreta spectrum - pathophysiology - prevention - patient management


Publication History

Article published online:
19 June 2023

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