Placenta accreta spectrum: diagnosis and management

Placenta accreta spectrum (PAS) is caused by abnormal placental attachment to the uterine wall that can involve invasion into the myometrium, uterine serosa or even surrounding organs. Women with suspected PAS should be referred to centres with appropriate expertise as they are associated with increased maternal morbidity and mortality. Women with PAS are at significant risk of haemorrhage and other surgical complications. Suspicion is raised in the presence of risk factors and the patient assessed with ultrasound scan. Once PAS is suspected skilled surgeons, anaesthetists and interventional radiologists should be involved in patient care and delivery planning. Unfortunately, not all cases are detected antenatally and when the condition is recognized only at the time of delivery the morbidity and mortality rates are higher. Urgent assistance of experienced surgeons should be sought in these cases to optimize the outcome for the patient.