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Placenta Accreta Spectrum Disorder

Abnormal adherence of the placenta to the uterine wall carries a serious risk of hemorrhage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Placenta Accreta Spectrum Disorder?

Placenta accreta spectrum (PAS) is the condition in which placental villi invade the myometrium instead of the decidua basalis. It can be superficial (accreta), moderate (increta - invasion into the myometrium) or deep (percreta - through the serosa, reaching the bladder).

Its incidence has increased 10-fold over the past 30 years with the rise in cesarean rates; today it is seen in 1/500 deliveries. Combination of previous cesarean and current placenta previa is the most important risk factor.

Massive bleeding, DIC, shock and hysterectomy may be required because the placenta does not separate during delivery. Treatment is managed by an experienced multidisciplinary team in the form of a planned cesarean-hysterectomy.

Symptoms

Mostly asymptomatic, diagnosis is made on ultrasound
Painless vaginal bleeding in the third trimester
May coexist with placenta previa
Lacunar flows on color Doppler
Loss of placenta-myometrium boundary
Irregularity at the bladder serosa (percreta)

Risk Factors

Previous cesarean (risk increases with each cesarean)
Cesarean combined with placenta previa
History of uterine surgery (myomectomy, curettage)
Asherman syndrome
Advanced maternal age
Multiple pregnancy and IVF

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Routine screening in a pregnant woman with previa and previous cesarean
  • In third trimester vaginal bleeding
  • When abnormal placental appearance is seen on ultrasound
  • Multidisciplinary consultation for planned delivery preparation
  • High-risk pregnancy follow-up in antenatal care

Treatment Methods

01
Diagnosis: ultrasound and MRI assessment when needed
02
Planned cesarean-hysterectomy (around 34-36 weeks)
03
Multidisciplinary team: perinatology, gynecology, urology, anesthesia
04
Blood product preparation and massive transfusion protocol
05
Internal iliac artery balloon occlusion (in selected cases)
06
Conservative management if fertility preservation is desired (selected)

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.