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Paving the Path to Prevent Peripartum Hysterectomies: Risk Stratification in Placenta Accreta Spectrum Cover

Paving the Path to Prevent Peripartum Hysterectomies: Risk Stratification in Placenta Accreta Spectrum

Open Access
|Aug 2025

Figures & Tables

Figure 1.

Gross morphology of abnormal placentation. A. Placenta increta: Cross-section showing invasion of placental tissue into the myometrium. B. Placenta accreta: Cross-section demonstrating placental adherence to the myometrium without significant invasion. C. Placenta percreta: Cross-section revealing placental invasion through the uterine wall, potentially involving serosa or adjacent organs.
Gross morphology of abnormal placentation. A. Placenta increta: Cross-section showing invasion of placental tissue into the myometrium. B. Placenta accreta: Cross-section demonstrating placental adherence to the myometrium without significant invasion. C. Placenta percreta: Cross-section revealing placental invasion through the uterine wall, potentially involving serosa or adjacent organs.

Figure 2.

Histological section showing placenta accreta with chorionic villi directly attached to the myometrium, lacking the intervening decidual layer (HE 10 ×).
Histological section showing placenta accreta with chorionic villi directly attached to the myometrium, lacking the intervening decidual layer (HE 10 ×).

Figure 3.

a. Histological section showing placenta increta with chorionic villi invading the myometrial tissue, indicating deeper penetration. (HE 40 ×) b. Histological section showing deep chorionic villi invasion of the myometrial tissue, which disrupts its architecture. (HE 40 ×).
a. Histological section showing placenta increta with chorionic villi invading the myometrial tissue, indicating deeper penetration. (HE 40 ×) b. Histological section showing deep chorionic villi invasion of the myometrial tissue, which disrupts its architecture. (HE 40 ×).

Figure 4.

Histological section showing placenta percreta with chorionic villi invading through the entire thickness of the myometrium, reaching the uterine serosa. (HE 10 ×).
Histological section showing placenta percreta with chorionic villi invading through the entire thickness of the myometrium, reaching the uterine serosa. (HE 10 ×).

Figure 5.

Distribution of key risk factors in Placenta Accreta Spectrum (PAS) cases.
Distribution of key risk factors in Placenta Accreta Spectrum (PAS) cases.

Figure 6.

Colour Doppler ultrasound images showing protrusion of placental tissues beyond the outer confines of the uterine myometrium, with thinning of the uterine serosa-bladder wall complex and increased vascularity between the serosa and the bladder.
Colour Doppler ultrasound images showing protrusion of placental tissues beyond the outer confines of the uterine myometrium, with thinning of the uterine serosa-bladder wall complex and increased vascularity between the serosa and the bladder.

Figure 7.

Proposed PAS risk model, with comprehensive scoring and risk categorisation system.
Proposed PAS risk model, with comprehensive scoring and risk categorisation system.

The table provides a detailed comparison of incidence rates, key risk factors and clinical outcomes between PAS and non-PAS cases

S. No.CategoryParameterNo. of PAS CasesNo. of PAS Cases (%)No. of Non-PAS CasesNo. of Non-PAS Cases (%)P-Value
1.Total cases9088850.93%9003 0.53
2.Clinical presentationAntenatal bleeding3541.2%370741.1%0.06
Postpartum haemorrhage1517.6%148216.46%0.1
Hypertension22.4%2112.3%0.3
Preterm labor44.7%3173.5%0.25
3.Risk factorsMultiparity7082.4%500055.5%0.0001
Previous caesarean sections
1 Previous3541.2%350038.9%0.05
2 Previous2529.4%200022.2%0.0001
3 + Previous1517.6%8008.9%0.002
Placenta praevia6070.6%200022.2%0.002
4.History of uterine SurgeriesMyomectomy1011.8%5005.6%0.005
Other surgeries89.4%4004.4%0.03
5.History of IVFPresent67.1%2002.2%0.05
6.Ultrasound & doppler findingsLoss of retroplacental Zone5058.8%150016.7%0.001
Placental lacunae4047.1%120013.3%0.002
Hypervascularity on Doppler5564.7%180020.0%0.0005
7.Maternal Outcomes≥ 4 Units transfused3035.3%300033.3%0.2
Hysterectomy required4047.1%500.6%0.0001
ICU admission89.4%7418.2%0.3
Mortality11.2%1051.16%0.5
8.Neonatal OutcomesPreterm Birth (< 37 weeks)6070.6%400044.4%0.0008
NICU Admission5058.8%350038.9%0.0015
DOI: https://doi.org/10.34763/jmotherandchild.20252901.d-25-00011 | Journal eISSN: 2719-535X | Journal ISSN: 2719-6488
Language: English
Page range: 83 - 92
Submitted on: Mar 27, 2025
Accepted on: Jun 29, 2025
Published on: Aug 16, 2025
Published by: Institute of Mother and Child
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 Ashmeet Kaur, Kalpana Mangal, Ankita Kumari Sharma, Mahi Gupta, Aditi Bansal, Pritosh Yadav, published by Institute of Mother and Child
This work is licensed under the Creative Commons Attribution 4.0 License.