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Towards precision medicine in placenta accreta spectrum: results from a survey-based evaluation of interactive academic international webinars.

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Uterus-preserving surgery for placenta accreta spectrum: An expert, illustrated review of techniques and its outcomes.

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Updated: Aug 5, 2025

Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes
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Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location.

José M Palacios-Jaraquemada1,2,3, Álbaro Nieto-Calvache4, Rozi Aditya Aryananda3,5

  • 1CEMIC University Hospital and Universitas Airlangga, Surabaya, Indonesia.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|March 26, 2023
PubMed
Summary

Lower parametrial placenta invasion (PPI) in placenta accreta spectrum (PAS) is rare but linked to higher maternal morbidity. Differentiating upper and lower PPI is crucial for surgical planning and patient outcomes.

Keywords:
Placenta accreta spectrumintraoperative diagnosismassive blood lossmaternal morbidityparametrial invasion

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Oncology
  • Maternal-Fetal Medicine

Background:

  • Placenta accreta spectrum (PAS) involving the parametrium presents unique surgical challenges.
  • Distinguishing between upper and lower parametrial placenta invasion (PPI) is essential for managing PAS complications.

Purpose of the Study:

  • To compare surgical approaches and morbidity associated with upper versus lower parametrial placenta invasion (PPI) in patients with PAS.
  • To identify key differences in surgical risks and technical considerations for upper and lower PPI.

Main Methods:

  • Retrospective analysis of 40 patients with PAS and parametrial involvement undergoing surgery between 2015-2020.
  • Classification of PPI into upper or lower based on peritoneal reflection, with surgical staging via pelvic fascia dissection.
  • Comparison of surgical techniques, including hysterectomy rates, vascular control methods, and complication rates (e.g., ureteral injury).

Main Results:

  • Of 40 patients, 13 had upper PPI and 27 had lower PPI; 33 diagnoses were MRI-confirmed.
  • Hysterectomy was performed in 2/13 upper PPI cases and all 27 lower PPI cases.
  • Ureteral injury occurred in 6 cases, primarily in those without adequate ureteral identification; proximal aortic control was effective, while internal iliac artery ligation was not.

Conclusions:

  • Lower parametrial placenta invasion (PPI) is associated with increased maternal morbidity compared to upper PPI.
  • Upper and lower PPI necessitate distinct surgical strategies, highlighting the need for accurate pre-operative diagnosis.
  • Risk factors such as prior uterine procedures (D&C, abortion, placental removal) warrant T2-weighted MRI for suspected PPI.