Placenta accreta: A review of the etiology, diagnosis, and management

Abstract

The incidence of placenta accreta is rising, primarily due to the increase in cesarean section rates. The prenatal diagnosis of placenta accretas has been shown to decrease the amount of blood loss and complications. Real-time ultrasound is helpful for diagnosing placenta accreta, and magnetic resonance imaging (MRI) can increase the sensitivity of prenatal diagnosis. Postpartum hysterectomy for placenta accreta has been the standard of therapy for placenta accreta, but conservative management including uterine artery embolization, and leaving the placenta in situ may be considered in patients who want to preserve their fertility. The etiology of placenta accreta is due to a deficiency of maternal decidua, resulting in placenta invasion into the uterine myometrium. The molecular basis is yet to be elucidated, but it probably involves abnormal paracrine or autocrine signaling between the deficient maternal decidua and the invading placenta trophoblastic tissue.