Placenta Accreta Spectrum Disorder

Key Clinical Points Placenta Accreta Spectrum The incidence of placenta accreta spectrum has increased by a factor of approximately 8 since the 1970s, probably owing to increases in cesarean delivery. Women with major risk factors, such as placenta previa, previous cesarean delivery, endometrial ablation, or other uterine surgery, should undergo obstetrical sonography in the middle-to-late second trimester to assess for possible placenta accreta spectrum. Patients with suspected placenta accreta spectrum should be referred to a center with multidisciplinary expertise and experience. Recommended management of suspected placenta accreta spectrum is planned cesarean hysterectomy with the placenta left in situ. However, surgical management may be individualized. In most cases, planned preterm delivery at 34 weeks of gestation is recommended to best balance maternal and neonatal risks. Earlier delivery may be warranted in women with labor, bleeding, or other complications.