Placenta accreta spectrum: risk factors, terminology, classification, management strategies

Abstract

The lecture is devoted to one of the most important and challenging obstetric complications, placenta accreta spectrum (PAS). Epidemiology, terminology, classification, prenatal diagnosis, and management strategies are considered. Materials of the FIGO consensus guidelines published in a series of papers are used. Special attention is paid to management strategies. It is shown that there is no definite treatment method for PAS. It all depends on the specific clinical situation, primarily the depth of placental invasion. The treatment should not be limited to expectant management, i.e., leaving the placenta in situ, since extravillous trophoblast cells continue to proliferate even after delivery, destroying the myometrium. In case of invasion of a limited placental fragment into the myometrium, the method of choice is operative hysteroscopy (hysteroresectoscopy), which provides a minimally traumatic approach to local placental invasion. Key words: accretion, placenta accreta, classification, diagnosis, management strategies