Placenta Accreta Spectrum Disorder

Overview

Placenta accreta spectrum disorder (PAS), also known as abnormally invasive placenta (AIP), depicts a clinical situation in which the placenta fails to detach spontaneously after delivery and has to be forcibly remove with the risk of having massive and potentially life threatening bleeding, or hemorrhage. Placenta accreta, in recent years, has been an increasingly more common condition among pregnant people. To be exact, the rates in which placenta accreta occur had quadrupled since the 1980s, which is unsurprising due to the increasing usage of the Cesarean section as the preferred surgical procedure of delivering babies out of the womb. Currently about 1 in 500 pregnancies will be involved with placenta accreta. Placenta accreta possesses a significantly high morbidity rate due to the failure by the post-delivery placenta to separate from the uterus. This condition is caused by the placenta growing too deeply into the uterine wall and fails to detach with it. The placenta accreta spectrum consists of placenta accreta, placenta increta, and placenta percreta in increasing severity. The majority (75-78%) of the confirmed diagnosis was revealed to be placenta accreta, placenta increta and percreta still made up about 17% and 5%, respectively. There are a lot of complications and symptoms that can be associated with placenta accreta, including infection, abnormal placental separation during delivery, postpartum hemorrhage, disseminated intravascular coagulation, potential emergency hysterectomy, maternal death, and premature labor. The most important risk factors for PAS are placenta previa (when the placenta implants low and overlays the cervix) and prior cesarean deliveries. There are multiple clinical screening diagnostics for placenta accreta, with the main ones being ultrasonography and magnetic resonance imaging. Grayscale ultrasonography is sensitive (77–87%) and specific (96–98%) for the diagnosis of placenta accreta. Ultrasonography is usually the most common prescribed and preferred method among doctors due to its accuracy and availability. The price range for obtaining an ultrasound is usually between $155 to $760. Magnetic resonance imaging, or MRI, may be helpful when the ultrasonography results are unclear or a suspicion of posterior placenta accreta. MRI works by employing strong magnetic fields and radio waves to obtain high accuracy images of internal organs and tissues. Because MRIs are more expensive, ranging from $1584 to $7600, they are less frequently ordered after a patient has had an indeterminate ultrasound result.