Placenta accreta, and its variants such as placenta accreta spectrum disorders (PAS-d), represents an emerging obstetric pathology burdened by high maternal-fetal mortality and morbidity, especially when the diagnosis is not made prior to delivery. PAS-d includes all forms of myometrial invasion which, due to an inadequate decidua basalis, are associated with anomalous penetration of the trophoblastic tissues through the myometrium up to the uterine serosa and beyond, such as into adjacent pelvic organs. PAS-d have recently been classified according to the degree of invasion, although different degrees of myometrial invasion can coexist within the same patient.
In recent years, the incidence of PAS-d is from 1/2500 to 1/500 deliveries worldwide, due to the increase rate of caesarean sections. It has also been termed a "20th century drug disease" due to the primary deciduo-myometrial defect in the uterus stemming from prior cuts, myomectomy, uterine courettage, or in vitro fertilization. The resulting decidual surgical damage can increase the possibility of blastocyst implantation in the scar area with consequential anchoring and anomalous invasion of the villi.
Dr. Gloria Calagna
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