Update on Placenta accreta spectrum Diagnosis and management challenges

Placenta accreta spectrum (PAS) disorders, also known as morbidly adherent placenta (MAP) include anomalous adherence of the placenta to implantation location. PAS could be classified into 3 categories based on the penetration distance of trophoblasts via the myometrium and serosa of the uterus into placenta accreta, increta, and percreta. A recent study in 2020 showed that using the introduced model based on 3 parameters; uterovesical vascularity, unusual lacunae (grades 2 and 3), and bladder wall interruption, has 100% accuracy in the diagnosis of PAS. Accurate diagnosis of morbidly adherent placenta (MAP), helps in multidisciplinary team management at delivery, with better maternal and neonatal outcomes. PAS could be suspected early in pregnancy by recognizing women with doubted Cesarean scar pregnancy (CSP) because CSP in the first trimester and PAS in the second and third trimesters might denote various stages of a similar pathology. Gray scale US with or without adding color Doppler and made by transabdominal or trans vaginal route are commonly utilized for prenatal screening and diagnosis of PAS. In a recent study made by Alalfy et, al in 2021 they revealed the systematic combined approach with the use of Alalfy Simple Criteria for assessment of placenta previa and PAS using 3D TUI (Tomographic Ultrasound Imaging and 3D power Doppler has a high diagnostic value in the diagnosis of PAS from the non-adherent placenta, the estimation of the myometrial thickness and the depth of placental invasion with the determination of different PAS subgroup plus defining diffuse from focal invasion (Fig. 2)