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
