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Uterus and Cervix

Uterus and Cervix

The uterus, commonly called the womb, is a vital reproductive organ in females designed to provide a nurturing environment for the implantation and growth of an embryo. It is shaped like a hollow pear and positioned between the urinary bladder and the rectum. The uterus's structure allows it to support and protect a developing fetus throughout pregnancy.
The uterus is securely anchored within the pelvic cavity by paired broad ligaments on either side. It is further stabilized by three pairs...

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Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes

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Placenta Accreta Spectrum Without Placenta Previa.

Daniela A Carusi¹, Karin A Fox, Deirdre J Lyell

¹Harvard Medical School, Boston, Massachusetts; Baylor College of Medicine, Houston, Texas; Stanford University, Stanford, California; University of Utah, Salt Lake City, Utah; and the Pan-American Society for Placenta Accreta Spectrum, Houston, Texas.

Obstetrics and Gynecology

|August 10, 2020

Summary

Placenta accreta spectrum without placenta previa is often diagnosed late, hindering multidisciplinary care. Severe maternal morbidity remains similar, highlighting the need for broader risk recognition and earlier diagnosis to improve outcomes.

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine

Background:

Placenta accreta spectrum (PAS) is a significant cause of obstetric morbidity.
Distinguishing PAS with and without placenta previa is crucial for management.

Purpose of the Study:

To compare risk factors, antepartum diagnosis, and maternal morbidity in placenta accreta spectrum cases with and without placenta previa.

Main Methods:

Retrospective cohort study of 351 pathology-confirmed PAS deliveries with hysterectomy.
Comparison of maternal, pregnancy, and delivery characteristics between previa and non-previa PAS groups.
Evaluation of surgical outcomes and severe maternal morbidities, including transfusion, reoperation, and organ injury.

Main Results:

Non-previa PAS was less likely to be diagnosed antepartum (38% vs 87%) and managed by multidisciplinary teams (41% vs 86%).
Non-previa PAS cases showed less invasive placental invasion (increta/percreta) but higher rates of operative hysteroscopy and in vitro fertilization.
Severe maternal morbidity rates were similar between groups (19% non-previa vs 20% previa), even after controlling for confounders.

Conclusions:

Placenta accreta spectrum without previa presents diagnostic challenges, potentially delaying multidisciplinary care.
Despite less invasive placental invasion, severe maternal morbidity is not reduced in non-previa PAS cases.
Enhanced recognition of at-risk patients is essential for improving early diagnosis and outcomes in placenta accreta spectrum.