Placenta accreta spectrum

被引：0

作者：

Eric Jauniaux ^{[1
]}

John D. Aplin ^{[2
]}

Karin A. Fox ^{[3
]}

Yalda Afshar ^{[4
]}

Ahmed M. Hussein ^{[5
]}

Carolyn J. P. Jones ^{[2
]}

Graham J. Burton ^{[6
]}

机构：

[1] University College London,EGA Institute for Women’s Health, Faculty of Population Health Sciences

[2] St Mary’s Hospital,Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester and Maternal and Fetal Health Centre

[3] University of Texas Medical Branch at Galveston,Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology

[4] University of California Los Angeles,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine

[5] University of Cairo,Department of Obstetrics and Gynecology, Kasr Al Ainy School of Medicine

[6] University of Cambridge,Loke Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience

来源：

Nature Reviews Disease Primers | / 11卷 / 1期

关键词：

D O I：

10.1038/s41572-025-00624-3

中图分类号：

学科分类号：

摘要：

Placenta accreta spectrum is an increasingly common placental-related disorder diagnosed at birth when the placenta cannot be fully detached manually from the uterine wall, often requiring a surgical removal. Following a worldwide increase in caesarean delivery rates, more than 90% of cases are now found in patients with a history of caesarean delivery and an anterior low-lying placenta or a placenta previa. Accreta placentation is not a consequence of an inherently more aggressive cancer-like trophoblast but of a loss of the normal physiological cell signalling and physical regulatory mechanisms in the scar tissue, with higher-than-normal maternal blood velocity entering the intervillous space of the placenta, distortion of the corresponding lobules and a loss of the physiological site of detachment from the uterine wall. If unsuspected at the time of delivery, attempts to manually remove accreta tissue are often associated with major and sometimes uncontrollable bleeding. Patients with a high probability of placenta accreta spectrum at birth can be generally identified by prenatal ultrasonography, permitting management by a multidisciplinary team. Owing to the high risk of intraoperative and postpartum haemorrhage and damage to other pelvic organs, placenta previa accreta presents a management challenge, particularly in healthcare systems with limited resources. Involving the pregnant patient and their family in preparation for delivery reduces psychological morbidity associated with complex obstetric surgery. Standardized reporting protocols are essential to develop new management strategies. Further research is required to characterize the complex cellular changes at the uteroplacental interface in placenta accreta spectrum.

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