Pathogenesis

Dr. Özgür Volkan Akbulut1
Dr. Seval Yılmaz Ergani2

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

ABSTRACT

Placenta accreta spectrum (PAS) disorders are characterized by abnormal invasion of trophoblasts into the myometrium and beyond, often diagnosed through histopathological examination. In typical placentation, trophoblast invasion ceases in the spongiosa layer of the decidua. However, prior uterine surgery can disrupt this process, leading to defective decidualization and subsequent PAS. The spectrum includes placenta accre- ta, increta, and percreta, classified by the depth of invasion into the myometrium and surrounding structures. The International Federation of Gynaecology and Obstetrics (FIGO) and the Society for Pediatric Pathology (SPP) have developed grading systems to categorize these disorders. PAS pathogenesis involves uterine scar- ring with defective re-epithelialization and altered vascularization contributing to abnormal placental adher- ence. Recent studies highlight the role of uterine blood flow, vascular resistance, and various growth factors and enzymes in the invasive behavior of extravillous trophoblasts. These findings underscore the complexity of PAS and its association with prior uterine interventions and pathologies.

Keywords: Decidualization; Myometrium; Placenta accreta spectrum, Placenca percreata; Trophoblast invasion

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