Pre-operative counseling regarding the extreme risk of catastrophic pelvic hemorrhage.
What is PAS?
Placenta Accreta Spectrum (PAS) involves abnormal trophoblast invasion into the myometrium. It is categorized into Accreta (attaches directly to myometrium), Increta (invades into myometrium), and Percreta (penetrates through serosa/bladder).
Bridging vessels spanning from placenta into bladder wall (Percreta)
Section 3
Pearls/Pitfalls
Absolute Contraindications
DO NOT attempt manual removal of the placenta if PAS is aggressively suspected or confirmed intraoperatively. Forcing a cleavage plane will trigger instant, massive, and virtually uncontrollable pelvic hemorrhage.
If diagnosed unexpectedly upon opening the abdomen during a routine C-section, do not disturb the placenta. Close the hysterotomy, pack the abdomen if needed, and call immediately for Gynecologic Oncology or a highly experienced surgical rescue team.
Section 4
Next Steps
Surgical Pathway (Confirmed Increta/Percreta)
01
Schedule controlled delivery at 34 0/7 to 35 6/7 weeks.
Perform classical (vertical) hysterotomy vastly superior to the placental edge to deliver the infant without cutting through the placenta.
04
Leave placenta strictly *in situ* undisturbed.
05
Proceed directly to total hysterectomy with the placenta still inside the uterus.
Section 5
Evidence Appraisal
Landmark References
Maternal morbidity associated with multiple repeat cesarean deliveries.
Silver RM et al. • Obstet Gynecol.. 2006;The massive definitive database study establishing the exact percentages mapping cesarean section count directly to Placenta Accreta risk in the presence of previa.
Placenta Accreta Spectrum.
ACOG Obstetric Care Consensus No. 7. • Obstet Gynecol.. 2018;Provides the current U.S. national standards for screening, ultrasound diagnosis, blood-banking preparation, and intentional non-removal algorithms.
Section 6
Literature
A Man-Made Epidemic
Placenta Accreta was exceptionally rare before the 1980s. The colossal rise in global cesarean section delivery rates created a man-made pathological phenomenon where fertilized eggs preferentially implant over scarred, defective anterior lower uterine segment tissue.
