Epidemiology and Risk Factors

Dr. Gizem Aktemur1
Dr. Nazan Vanlı Tonyalı2

1Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye

ABSTRACT

Placenta accreta spectrum (PAS) disorders, encompassing placenta accreta, increta, and percreta, are char- acterized by abnormal trophoblast invasion into the uterine myometrium, either partially or completely. These conditions significantly contribute to maternal morbidity and mortality worldwide. The incidence of PAS has risen, primarily due to increased cesarean deliveries and other uterine surgeries, which are major risk factors. The global prevalence of PAS varies, with recent estimates ranging from 0.01% to 1.1% of all pregnancies in high- and middle-income countries.

Historical data traces the first report of placenta accreta to 1927, with significant findings published in 1937 reporting a frequency of 0.12%. Current hypotheses suggest that PAS originates from defects in the endome- trial and myometrial layers at previous hysterotomy sites, disrupting normal decidualization. The prevalence of PAS is approximately 0.4%, with a meta-analysis in 2019 reporting an overall prevalence of 0.17%. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) guidelines indicate that placenta accreta, increta, and percreta account for 69.5%, 23.7%, and 6.8% of cases, respectively.

Risk factors for PAS include the number of previous cesarean sections, with increased odds ratios correspond- ing to the number of cesareans. Placenta previa is another significant risk factor. Assisted reproductive tech- niques and previous uterine surgeries also contribute to increased risk. Recent studies emphasize the need for enhanced surveillance, early diagnosis, and comprehensive management strategies to improve maternal and neonatal outcomes. The introduction of advanced imaging techniques has improved the identification and management of PAS, highlighting the importance of a multidisciplinary approach for affected pregnancies.

In conclusion, the rising incidence of PAS underscores the need for improved diagnostic and management protocols, particularly for patients with placenta previa and multiple cesarean sections. Multidisciplinary cen- ters with expertise in PAS should be involved in managing these high-risk pregnancies to optimize outcomes.

Keywords: Placenta accreta spectrum; Cesarean delivery; Risk factors; Prenatal diagnosis; Maternal morbidity and mortality

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