Skip to main content Accessibility help
Hostname: page-component-684899dbb8-ndjvl Total loading time: 2.939 Render date: 2022-05-19T00:32:33.012Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

Chapter 64 - Placenta Accreta Spectrum Disorders

from Section 7 - Placenta

Published online by Cambridge University Press:  20 November 2021

Tahir Mahmood
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
University of Malta, Malta
Ioannis Messinis
University of Thessaly, Greece
Sambit Mukhopadhyay
Norfolk & Norwich University Hospital, UK
Get access


Placental adhesive spectrum disorders (PASD) are on the increase. Histologically, the placenta may be adherent to the myometrium without intervening decidua (acreta), invade the myometrium (increta) and/or extend beyond the myometrium and seen via the serosa of the uterus or invade into adjacent tissues like the bladder or parametrium (percreta). Since there are difficulties in defining each entity by ultrasound or by histology and also due to the possibility of histology showing different degrees of invasion in the same case, PASD is the term now commonly used and the previous terminology of morbidly adherent placenta is no longer used. The main contributor towards PSAD is previous caesarean section (CS). With the global increase in CS, the incidence of PASD and related morbidity and mortality is on the increase.

The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
, pp. 518 - 524
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Jauniaux, E, Ayres deCampos, D. FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet. 2018 Mar;140(3):261–4.Google ScholarPubMed
Jauniaux, E, Chantraine, F, Silver, RM, et al. FIGO consensus guidelines on placenta accreta spectrum disorders; epidemiology. Int J Gynaecol Obstet. 2018 Mar;140(3):265–72.Google ScholarPubMed
Jauniaux, E, Bhide, A, Kennedy, A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders; prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018 Mar;140(3):274–80.Google ScholarPubMed
Allen, L, Jauniaux, E, Hubinent, R, et al. FIGO consensus guidelines on placenta accreta spectrum disorders; non conservative surgical management. Int J Gynaecol Obstet. 2018 Mar;140(3):281–90.CrossRefGoogle Scholar
Sentilhes, L, Kayem, G, Chandraharan, E, Palacios-Jaraquemada, J, Jauniaux, E. FIGO consensus guidelines on placenta accreta spectrum disorders; conservative management. Int J Gynaecol Obstet. 2018 Mar;140(3):291–8.CrossRefGoogle ScholarPubMed
Silver, RM, Fox, KA, Barton, JR, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015;212:561–8. doi: 10.1016/j.ajog.2014.11.018CrossRefGoogle ScholarPubMed
Jauniaux, E, Alfirevic, Z, Bhide, AG, et al.; Royal College of Ostetricians and Gynaecologists. Placenta praevia and placenta accreta: diagnosis and management: Green-top Guideline No. 27a. BJOG. 2019;126: e1e48. doi: 10.1111/1471-0528.15306CrossRefGoogle ScholarPubMed
D’Antonio, F, Iacovella, C, Bhide, A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2013;42:509–17. doi: 10.1002/uog.13194Google ScholarPubMed
Comstock, CH, Love, JJ Jr, Bronsteen, RA, et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol 2004;190:1135–40. doi: 10.1016/j.ajog.2003.11.024CrossRefGoogle ScholarPubMed
Finberg, HJ, Williams, JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992;11:333–43.CrossRefGoogle ScholarPubMed
Bhide, A, Laoreti, A, Kaelin Agten, A, et al. Lower uterine segment placental thickness in women with abnormally invasive placenta. Acta Obstet Gynecol Scand. 2019;98:95100. doi: 10.1111/aogs.13422CrossRefGoogle ScholarPubMed
D’Antonio, F, Iacovella, C, Palacios-Jaraquemada, J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014;44:816. doi: 10.1002/uog.13327CrossRefGoogle ScholarPubMed
Sentilhes, L, Goffinet, F, Kayem, G. Management of placenta accreta. Acta Obstet Gynecol Scand. 2013;92:1125–34.Google ScholarPubMed
Timmermans, S, van Hof, AC, Duvekot, JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv. 2007;62:529–39.CrossRefGoogle ScholarPubMed
Athanasias, P, Krishna, A, Karoshi, M, Moore, J, Chandraharan, E. Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta. J Obstet Gynaecol. 2013;33(8):906–7.CrossRefGoogle ScholarPubMed
Fox, KA, Shamshirsaz, AA, Carusi, D, et al. Conservative management of morbidly adherent placenta: Expert review. Am J Obstet Gynecol. 2015;213:755–60.CrossRefGoogle ScholarPubMed
Meyer, NP, Ward, GH, Chandraharan, E. Conservative approach to the management of morbidly adherent placentae. Ceylon Med J. 2012 Mar;57(1):36–9.CrossRefGoogle ScholarPubMed
Chandraharan, E, Rao, S, Belli, A-M, Arulkumaran, S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int Journal of Obstet & Gynecol. 117;2012:191–4.CrossRefGoogle ScholarPubMed
Pinas Carrillo, A, Chandraharan, E. Management of morbidly adherent placenta. Obstet Gynaecol Reproduc Med. 2016;26(10):283–90.Google Scholar
Doncheva, P, Chandraharan, E. Effectiveness of PerClot: a topical haemostatic agent to reduce intra-operative bleeding during ‘triple P procedure’ for morbidly adherent placentae: a case series. BJOG. 2013;120:s1:1718.Google Scholar
Teixidor Viñas, M, Chandraharan, E, Moneta, MV, Belli, AM. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Clin Radiol. 2014 Aug;69(8):e345–51.CrossRefGoogle ScholarPubMed
Teixidor Vinas, M, Belli, AM, Arulkumaran, S, Chandraharan, E. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after the introduction of the Triple P procedure. Ultrasound Obstet Gynecol. 2015;46:350–5.CrossRefGoogle ScholarPubMed
El Tahan, M, Carrillo, AP, Moore, J, Chandraharan, E. Predictors of postoperative hospitalisation in women who underwent the Triple-P procedure for abnormal invasion of the placenta. J Obstet Gynaecol. 2018 Jan;38(1):71–3.CrossRefGoogle ScholarPubMed
Tskhay, VB, Yametov, PK, Yametova, NM. The use of modified triple-p method with adherent placenta long- term results. MOJ Womens Health.2017;4(2):00079.Google Scholar
Wei, Y, Cao, Y, Yu, Y, Wang, Z . Evaluation of a modified ‘Triple-P’ procedure in women with morbidly adherent placenta after previous caesarean section. Arch Gynecol Obstet. 2017 Oct;296(4):737–43.CrossRefGoogle ScholarPubMed
Cauldwell, M, Chandraharan, E, Pinas Carillo, A, Pereira, S. The first reported case of successful pregnancy outcome following conservative management of placenta percreta using the Triple P Procedure. Ultrasound Obstet Gynecol. 2017. doi: 10.1002/uog.17566CrossRefGoogle Scholar
Palacios-Jaraquemada, JM, Pesaresi, M, Nassif, JC, Hermosid, S. Anterior placenta percreta: Surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83:738–44.CrossRefGoogle ScholarPubMed
El Gelany, SA, Abdelraheim, AR, Mohammed, MM, et al. The cervix as a natural tamponade in postpartum hemorrhage caused by placenta previa and placenta previa accreta: a prospective study. BMC Pregnancy Childbirth. 2015;15:295.CrossRefGoogle ScholarPubMed
Wright, JD, Pri-Paz, S, Herzog, TJ, et al. Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gynecol. 2011;205:38e1CrossRefGoogle ScholarPubMed
Hoffman, MS, Karlnoski, RA, Mangar, D, et al. Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol. 2010;202: e15.CrossRefGoogle ScholarPubMed
Eller, AG, Bennett, MA, Sharshiner, M, et al. Maternal morbidity in cases of placenta accrete managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. 2011;117:331.CrossRefGoogle Scholar
Awan, N, Bennett, MJ, Walters, WA. Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for Women, Sydney. Aust N Z J Obstet Gynaecol. 2011;51:210.CrossRefGoogle Scholar
Wright, JD, Devine, P, Shah, M, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol. 2010;115:1187.CrossRefGoogle ScholarPubMed
Knight, M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007;114:1380.CrossRefGoogle ScholarPubMed
Yucel, O, Ozdemir, I, Yucel, N, Somunkiran, A. Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet. 2006;274:84.CrossRefGoogle ScholarPubMed
Tam Tam, KB, Dozier, J, Martin, JN Jr. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: A systematic review. J Matern Fetal Neonatal Med. 2012;25:329–34.CrossRefGoogle ScholarPubMed
Perez-Delboy, A, Wright, JD. Surgical management of placenta accreta: to leave or remove the placenta? BJOG. 2014;121:163–70.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats