Clinicoradiological and Histopathological Correlation of Placenta Accreta Spectrum (PAS)

Placenta accreta spectrum (PAS) is a major cause of pregnancy-related mortality and morbidity in developed countries. To diagnose placenta accreta, high diagnostic consideration and good radiological examination is crucial. Intraoperative finding and histopathological examination confirm the diagnosis made clinically. So we have conducted the present study aiming to do correlation of clinical and radiological findings and histological examination of peripartum hysterectomy specimen of PAS patients.

It is ambispective observational study, done at our institute from January 2021 to December 2024, after ethical clearance. All patients of suspected PAS who were managed surgically with hysterectomy are included. Data collected and correlated with clinical and radiological and histopathological reports.

Data were collected and analysed for 43 women. All 43 women have h/o scarred uterus with placenta previa, intraoperatively positive finding was found in more than 80% of women (large vessels at lower segment-86%, bulge at lower segment-72%, bladder invasion-12%, broad ligament invasion-5%). Ultrasonography (USG) diagnosed or suspected PAS in 79%, in 21% women, PAS was ruled out by USG (false negative). Magnetic resonance imaging (MRI) report was s/o PAS in 100% women (True Positive). All 43 women were diagnosed with adhered placenta histopathologically, in 34 women Placenta accreta (79%), 5 Placenta increta (12%), and 4 women Placenta percreta (9%) was detected.

Any pregnant women with history of scarred uterus or previous caesarean section (LSCS) and placenta previa should be evaluated for PAS by USG and MRI and should be managed in tertiary centre. Also the degree of invasion can vary and may be missed in imaging. So intraoperative finding and histopathological examination are critical for final diagnosis.