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Congress: ECR24
Poster Number: C-24309
Type: EPOS Radiologist (educational)
DOI: 10.26044/ecr2024/C-24309
Authorblock: E. A. Cadag, S. D. L. Gosiaco, S. G. F. Estanislao, K. R. T. Yu, S. S. Chny, J. V. A. Tamayo; Taguig City/PH
Disclosures:
Eazels Abrantes Cadag: Nothing to disclose
Stacey Danica Lim Gosiaco: Nothing to disclose
Seth Gabriel Ferrer Estanislao: Nothing to disclose
Kevin Ryan Ting Yu: Nothing to disclose
Stacy Sua Chny: Nothing to disclose
Jose Victor Abad Tamayo: Nothing to disclose
Keywords: Genital / Reproductive system female, MR, Chemoembolisation, Obstetrics
Background

Placenta Accreta Spectrum (PAS) disorders encompass various degrees of pathologic placental implantation and are classified on the basis of the depth of myometrial invasion

Fig 1: Placenta Accreta Spectrum. Diagram courtesy of Frank Gaillard, Radiopaedia.org, rID: 167145

 

Placenta accreta is the mildest and most common among the PAS disorders wherein villi only attach to the myometrium without invasion of the underlying muscle. Placenta increta is the intermediate form with partial invasion of the myometrium. The most severe form is placenta percreta where the villi penetrate through the entire myometrium or even beyond the serosa into adjacent organs.

The leading hypothesis is that PAS is due to the deficiency of the endometrial-myometrial interface leading to failure of normal decidualization, often in the area of a uterine scar, which allows deep chorionic villi and trophoblast infiltration. PAS disorders have increased in parallel with the increased rates of cesarean section and placenta previa, its most significant risk factors. Global cesarean section rates are predicted to be around 40-60% by 2030[1]. The incidence of PAS has increased nearly ten times in the last five decades and represents a significant contributor to maternal health complications and deaths due to massive obstetric hemorrhage with around 52% necessitating peripartum hysterectomy [2].

Ultrasound remains the first-line imaging modality in assessment of PAS. Recently, MRI has been increasingly utilized for diagnosis and pre-surgical evaluation of myoinvasion and extrauterine spread. Standardizing imaging criteria is crucial for consistent reporting and diagnosis, ultimately guiding timely and tailored clinical interventions for improved patient outcomes.

GALLERY