Current studies

 01/02/2025 - 31/01/2027 Placenta Accreta Spectrum

 

BACKGROUND

Placenta Accreta Spectrum

Placenta Accreta Spectrum (PAS) is a pathological condition in placentation where villous tissue adheres to or invades the uterine wall without the interposing decidua1. The global incidence of PAS is rising, driven primarily by the increasing prevalence of Caesarean deliveries, which is a major risk factor for PAS in subsequent pregnancies1,2. The primary impact of PAS is the significant risk of massive obstetric hemorrhage during delivery, one of the leading and potentially preventable causes of maternal death. PAS poses major challenges in modern obstetric care, necessitating accurate and timely diagnosis and vigilant prenatal screening to reduce maternal morbidity and mortality and optimise foetal outcomes1,3,4. Increasing evidence suggests that managing PAS cases with multidisciplinary teams in tertiary centers reduces maternal morbidity and mortality compared to standard obstetric care. Three grades of PAS are considered in the FIGO classification: 

  • (1) abnormally adherent placenta (placenta adherent or creta) - attached directly to the surface of the middle layer of the uterine wall (myometrium) without invading it;
  • (2) abnormally invasive placenta (increta) - invasion into the myometrium; and
  • (3a , 3b & 3c) abnormally invasive placenta (percreta) - invasion may reach surrounding pelvic tissues, vessels and organs.1,2 

This observational study has two objectives. First, to evaluate the incidence of PAS in Belgium, which is of interest given the moderate increase in caesarean rates (Brussels 20.9%, Wallonia 22.8%, Flanders 22.6% in 2022) and a fertility rate of 1.46 children per woman. Secondly, we aim to assess the management of PAS in Belgium and the outcomes for both mother and newborn.

These data will provide valuable information for counseling women, developing management guidelines, and establishing a baseline incidence to monitor future trends if caesarean rates continue to rise nationally. A coordinated and comprehensive approach by a multidisciplinary team minimizes complications and optimizes outcomes in high-risk obstetric scenarios5.

References

  1. Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox K.A, Collins S (2019) FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Obstet Gynecol Int J; 146: 20–24. DOI: 10.1002/ijgo.12761.
  2. Jauniaux E, Ayres-de-Campos D; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction. Int J Gynaecol Obstet. 2018 Mar;140(3):261-264. doi: 10.1002/ijgo.12406. PMID: 29405322.
  3. Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018 Mar;140(3):265-273. doi: 10.1002/ijgo.12407. PMID: 29405321.
  4. Hall T, Wax J.R, Lucas F.L, Cartin A, Jones M, Pinette M.G (2014) Prenatal sonographic diagnosis of placenta accreta—impact on maternal and neonatal outcomes. J Clin Ultrasound; 42: 449–455. DOI: 10.1002/jcu.22186.
  5. Nieto-Calvache A.J, Vergara-Galliadi L.M, Rodríguez F, Ordoñez C.A, García A.F, López M.C, Manzano R, Velásquez J, Carbonell J.P, Bryon A.M, Echavarría M.P, Escobar M.F, Carvajal J, Benavides-Calvache J.P, Burgos J.M (2021) A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum. J Trauma Acute Care Surg; 90: 807–816.