Placenta Accreta Spectrum (PAS): Diagnosis and Management

- Introduction

Placenta Accreta Spectrum (PAS) is a life-threatening obstetric condition characterized by abnormal placental adherence to the uterine wall, leading to significant maternal morbidity and mortality.

The global rise in Cesarean section rates has contributed to an increased incidence of PAS, making it a critical concern in obstetric practice.

 In Egypt, the Cesarean delivery rate increased from 52 % in 2014 to 72% in 2021 (1), with a corresponding increase in PAS represents a growing challenge for obstetricians, anesthetists, and multidisciplinary teams involved in peripartum care and placing a substantial burden to the healthcare system.

While precise national statistics on PAS remain limited, hospital-based studies estimate an incidence ranging from 3 - 9 in 1000 births (2,3), significantly higher than the global average of 0.5 - 1 in 1000 births (4)

Classification:

• Placenta accreta: densely adherent placenta due to abnormally deep invasion of the placenta onto the uterine muscle (possibility placenta will separate at birth).
• Placenta increta: adherent placenta embedded into the uterine muscle wall (placenta unlikely to separate at birth).
• Placenta percreta: adherent placenta growing through the uterus and with possible involvement of other organs (placenta unlikely to separate at birth (5)