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Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes
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What is placenta accreta?

Eric Jauniaux1, Brett D Einerson2, Ahmed M Hussein3

  • 1EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.

American Journal of Obstetrics and Gynecology
|January 4, 2026
PubMed
Summary
This summary is machine-generated.

Placenta accreta spectrum arises from placental development defects at sites lacking normal uterine defenses, not inherently invasive tissue. Accurate diagnosis requires focusing on deep villous attachment and uteroplacental interface changes, not just decidua absence.

Keywords:
abnormal villous attachmentinvasive placentationplacenta accreta spectrum disordersplacenta incretaplacenta percretauterine atony

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Area of Science:

  • Obstetrics and Gynecology
  • Pathology
  • Reproductive Medicine

Background:

  • Placenta accreta spectrum (PAS) is a complex obstetric condition often linked to prior cesarean delivery and placenta previa.
  • Current understanding questions the concept of overinvasive placentation, suggesting surgical manipulation may contribute to placental tissue extrusion.
  • PAS is increasingly reported in patients without prior uterine surgery, challenging traditional diagnostic criteria.

Purpose of the Study:

  • To re-evaluate the pathophysiology of placenta accreta spectrum.
  • To challenge the traditional histopathologic diagnosis of accreta.
  • To propose a new clinicopathologic classification for PAS.

Main Methods:

  • Review of existing literature and clinical data on placenta accreta spectrum.
  • Analysis of histopathologic findings in accreta cases.
  • Critique of current diagnostic criteria and surgical management strategies.

Main Results:

  • Evidence suggests PAS results from placental development at sites with deficient decidual and myometrial mechanisms, not inherently invasive villous tissue.
  • Surgical manipulation of the lower uterine segment may cause placental tissue extrusion, mimicking percreta.
  • Traditional histopathologic reliance on decidua basalis absence is inadequate; focus should shift to deep villous attachment and uteroplacental interface changes.

Conclusions:

  • Placenta accreta spectrum is a consequence of abnormal placental development at scar sites.
  • Current diagnostic methods, particularly histopathology, require revision.
  • A new classification based on topographic intraoperative descriptions and detailed microscopic features is needed for improved management and outcomes.