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

Ashmeet Kaur

Ashmeet Kaur

Department of Pathology, SMS Medical CollegeJaipur, India
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Kaur, Ashmeet
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Kalpana Mangal

Kalpana Mangal

Department of Pathology, SMS Medical CollegeJaipur, India
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Mangal, Kalpana
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Ankita Kumari Sharma

Ankita Kumari Sharma

Department of Pathology, SMS Medical CollegeJaipur, India
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Sharma, Ankita Kumari
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Mahi Gupta

Mahi Gupta

Department of Pathology, Geetanjali Medical College and HospitalUdaipur, India
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Gupta, Mahi
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Aditi Bansal

Aditi Bansal

Department of Obstetrics and Gynecology, Zanana Hospital, SMS Medical College and HospitalJaipur, India
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Bansal, Aditi
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Pritosh Yadav

Pritosh Yadav

Department of Pathology, SMS Medical CollegeJaipur, India
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Yadav, Pritosh
  
Aug 16, 2025
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Article Category: Original Research
Published Online: Aug 16, 2025
Page range: 83 - 92
Received: Mar 27, 2025
Accepted: Jun 29, 2025
DOI: https://doi.org/10.34763/jmotherandchild.20252901.d-25-00011
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© 2025 Ashmeet Kaur et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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. Category Parameter No. of PAS Cases No. of PAS Cases (%) No. of Non-PAS Cases No. of Non-PAS Cases (%) P-Value
1. Total cases 9088 85 0.93% 9003 0.53
2. Clinical presentation Antenatal bleeding 35 41.2% 3707 41.1% 0.06
Postpartum haemorrhage 15 17.6% 1482 16.46% 0.1
Hypertension 2 2.4% 211 2.3% 0.3
Preterm labor 4 4.7% 317 3.5% 0.25
3. Risk factors Multiparity 70 82.4% 5000 55.5% 0.0001
Previous caesarean sections
1 Previous 35 41.2% 3500 38.9% 0.05
2 Previous 25 29.4% 2000 22.2% 0.0001
3 + Previous 15 17.6% 800 8.9% 0.002
Placenta praevia 60 70.6% 2000 22.2% 0.002
4. History of uterine Surgeries Myomectomy 10 11.8% 500 5.6% 0.005
Other surgeries 8 9.4% 400 4.4% 0.03
5. History of IVF Present 6 7.1% 200 2.2% 0.05
6. Ultrasound & doppler findings Loss of retroplacental Zone 50 58.8% 1500 16.7% 0.001
Placental lacunae 40 47.1% 1200 13.3% 0.002
Hypervascularity on Doppler 55 64.7% 1800 20.0% 0.0005
7. Maternal Outcomes ≥ 4 Units transfused 30 35.3% 3000 33.3% 0.2
Hysterectomy required 40 47.1% 50 0.6% 0.0001
ICU admission 8 9.4% 741 8.2% 0.3
Mortality 1 1.2% 105 1.16% 0.5
8. Neonatal Outcomes Preterm Birth (< 37 weeks) 60 70.6% 4000 44.4% 0.0008
NICU Admission 50 58.8% 3500 38.9% 0.0015
Language:
English
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1 times per year
Journal Subjects:
Medicine, Clinical Medicine, Pediatrics and Juvenile Medicine, Paediatric Haematology and Oncology, Public Health
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