Intrapartum Diagnosis and Grading

Dr. Mevlüt Bucak1
Dr. Betül Tokgöz Çakır2

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

ABSTRACT

Placenta accreta spectrum (PAS) is a condition characterized by a defect in the decidua basalis, with a high mortality and morbidity risk due to previous cesarean section scars. The incidence of PAS is gradually increas- ing worldwide. Prenatal detection of an abnormal placenta and referral of the patient to experienced centers are crucial. However, prenatal investigations can sometimes be inadequate, so cavities and vascular anatomy play an important role in diagnosis as well as staging and treatment in PAS surgery.

The International Federation of Gynecology and Obstetrics (FIGO) classification is widely used for intraoper- ative assessment. While in Grade 1, no placental tissue can be seen macroscopically on the uterine tissue, in Grade 2, there are abnormal macroscopic findings on the placental bed (bluish or purple coloration, expan- sion, or “bulging” of the placenta). In Grade 3a, the placenta is limited to the serosa of the uterus; in Grade 3b, the bladder is affected, and in Grade 3c, other pelvic organs are affected.

More research on diagnostic and management approaches is needed to ensure an evidence-based approach to cases of PAS.

Keywords: Clinicopathological classification; Pelvic cavities; Placenta accreta spectrum

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