Placenta Accreta and Cesarean Scar Pregnancy: Overlooked Costs of the Rising Cesarean Section Rate

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 622 West 168th Street, PH 16-66, Columbia University, New York, NY 10032, USA.
Clinics in Perinatology (Impact Factor: 2.44). 10/2008; 35(3):519-29, x. DOI: 10.1016/j.clp.2008.07.003
Source: PubMed


An unintended consequence of the rising cesarean section rate is abnormal placentation in subsequent pregnancies, leading to the clinical complications of placenta accreta and cesarean scar pregnancies. Both of these clinical entities are associated with high rates of maternal morbidity and mortality. This article reviews the potential mechanisms by which uterine scarring may lead to abnormal trophoblast invasion, the association of cesarean section with placenta accreta and scar pregnancies, current management, and suggestions for future research to reduce the incidence of these potentially devastating complications of pregnancy.


Available from: Todd Rosen, Feb 24, 2015
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    • "Commonly named risk factors for disturbances in placental disruption, such as placenta accreta, are history of retained placenta, previous caesarean section, maternal age over 35 years, preterm labour, induced labour, multiparity, previous uterine injury or surgery, uterine malformations, infection, and preeclampsia [1, 3, 6–8, 14–18]. It is believed that placenta accreta is becoming more common due to the rising caesarean section rate and advancing maternal age, both independent risk factors for placenta accreta [2, 17]. "
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    ABSTRACT: The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.
    Journal of pregnancy 04/2014; 2014(6):274651. DOI:10.1155/2014/274651
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    • "Evidence of maternal repression also exists in this context, as invasive placental cells can inappropriately extend as far as the mother's bladder after the uterus has been compromised by scarring (Washecka and Behling, 2002). This inappropriate invasion leads to the pregnancy disease percreta, which was rare 20 years ago, but due to extensive C-sections performed in the United States its incidence is on the rise (Rosen, 2008; Sinha and Mishra, 2012). Again, this suggests that there is a maternal repressive signal present in the uterus used to 'block' fetal cell invasion. "
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    ABSTRACT: In all mammals including humans, development takes place within the protective environment of the maternal womb. Throughout gestation, nutrients and waste products are continuously exchanged between mother and fetus through the placenta. Despite the clear importance of the placenta to successful pregnancy and the health of both mother and offspring, relatively little is understood about the biology of the placenta and its role in pregnancy-related diseases. Given that pre- and peri-natal diseases involving the placenta affect millions of women and their newborns worldwide, there is an urgent need to understand placenta biology and development. Here, we suggest that the placenta is an organ under unique selective pressures that have driven its rapid diversification throughout mammalian evolution. The high divergence of the placenta complicates the use of non-human animal models and necessitates an evolutionary perspective when studying its biology and role in disease. We suggest that diversifying evolution of the placenta is primarily driven by intraspecies evolutionary conflict between mother and fetus, and that many pregnancy diseases are a consequence of this evolutionary force. Understanding how maternal–fetal conflict shapes both basic placental and reproductive biology – in all species – will provide key insights into diseases of pregnancy.
    Applied and Translational Genomics 12/2013; 2(1). DOI:10.1016/j.atg.2013.07.001

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