Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum

Placenta accreta spectrum includes the full range of abnormal placental attachment to uterus or other structures, encompassing placenta accreta, increta, percreta, morbidly adherent placenta, and invasive placentation. The incidence has increased in recent years, largely driven by increasing rates cesarean delivery. Prenatal detection is primarily made ultrasound important reduce maternal morbidity associated with condition. Despite a large body research on various markers their screening performance, inconsistencies literature persist. In response need for standardizing definitions approach examination, Society Maternal-Fetal Medicine convened task force representatives from American Institute Ultrasound Medicine, College Obstetricians Gynecologists, Radiology, International Obstetrics Gynecology, Radiologists Ultrasound, Registry Diagnostic Medical Sonography, Gottesfeld-Hohler Memorial Foundation. goals were assess sonographic basis available data expert consensus, provide standardized prenatal evaluation pregnancies at risk spectrum, identify gaps field. This manuscript provides information Accreta Spectrum Task Force process findings. Maternal Fetal (SMFM), (AIUM), (ACR), Gottesfeld Hohler (GOHO) endorse this document. Gynecologists (ACOG) Gynecology (ISUOG) support (SRU) approves (PAS), terms placentation, structures. There been dramatic rise PAS over years.1Creanga A.A. Bateman B.T. 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Expert opinion obtained when could not marker and/or screening. addition, noted.Table 1Task participating members societiesAlfred AbuhamadSMFM, Co-ChairScott ShainkerSMFM, Co-ChairBeverly ColemanACRIlan Timor-TritschGOHOAmarnath BhideISUOGBryann BromleyAIUMAlison CahillACOGJoshua CopelGOHOManisha GhandiACOGJonathan HechtaPathology consultant, Department Pathology, Beth Israel Deaconess Center Harvard School, MA.Katherine JohnsonSMFMDeborah LevineSRUJoan MastrobattistaAIUMJennifer PhilipsSMFMLawrence PlattGOHOAlireza ShamshirsazGOHOThomas ShippARDMSRobert SilverSMFMLynn SimpsonSMFMACOG, Gynecologists; ACR, Radiologists; AIUM, Medicine; ARDMS, Sonography; GOHO, Society; ISUOG, Gynecology; SMFM, SRU, Ultrasound.Shainker. Special Report SMFM: Definition examination PAS. 2021.a Pathology MA. Open table new tab ACOG, Ultrasound. Shainker. 2021. As outlined Consensus, primary PAS.7American can be seen early trimester, although historically predominantly pregnancy. strongest association persistent time setting delivery.5Warshak Scholar,43Eller Bennett Sharshiner compared standard care.Obstet 117: 331-337Crossref (298) Other classic include (Figure 1), loss retroplacental hypoechoic 2), thinning myometrium 3), hypervascularity uterovesicle space 4), extension bladder, bridging (Figures 5 6).11Calì Scholar,39Comstock Scholar,44Esakoff T.F. Sparks T.N. Kaimal al.Diagnosis accreta.Ultrasound 37: 324-327Crossref (94) 45Warshak 108: 573-581Crossref (366) 46Jauniaux Collins Jurkovic Burton G.J. placentation: systematic grading villous invasiveness.Am 215: 712-721Abstract (116) excessive flow along 6).6Belfort Scholar,46Jauniaux Scholar,47Jauniaux spectrum: pathophysiology evidence-based anatomy imaging.Am 218: 75-87Abstract (266) ScholarFigure 2Retroplacental zoneShow captionTransvaginal midline sagittal grayscale previa. A, Normal-appearing (arrows). B, Abnormal (arrows) spectrum.Shainker. 2021.View Large Image Figure ViewerDownload Hi-res Download (PPT)Figure 3Myometrial thinningShow captionTransabdominal focal spectrum. area myometrial thickness (asterisks) areas (arrows).Shainker. 4Hypervascularity spaceShow (A) (B) demonstrating space. Note blood clot (asterisk) lower segment.Shainker. 5Uteroplacental interfaceShow Grayscale irregularities bulging segment (asterisk). Color highlighting within interface.Shainker. 6Abnormal contour vesselShow (small arrows) interruption (large arrow). vessel site arrow).Shainker. (PPT) Transvaginal retroplacenta