HISTOPATHOLOGICAL CORRELATION OF PLACENTA ACCRETA SPECTRUMWITH CLINICAL AND INTRAOPERATIVE FINDINGS

Abstract

Background: Placenta accreta spectrum (PAS) comprises abnormal placental adherence and/or invasion and is associated with major maternal morbidity, especially obstetric hemorrhage, transfusion and urinary tract injury. Antenatal imaging is central to diagnosis and operative planning, while histopathology provides tissue-based confirmation when hysterectomy or uterine resection specimens are available.
Aim: To evaluate the histopathological spectrum of PAS and correlate pathological findings with antenatal imaging, risk factors and intraoperative findings in a 100-case cohort.
Methods: One hundred women with suspected or clinically diagnosed PAS who underwent cesarean hysterectomy or uterine resection were done. Maternal age, parity, previous cesareans, placenta previa/low-lying placenta, antenatal ultrasound/MRI impression, estimated blood loss, transfusion and urologic injury were recorded. Histopathology assessed the placental implantation site and depth of villous invasion. Descriptive statistics and cross-tabulation were used.
Results: Mean maternal age was 31.9 ± 5.0 years. Previous cesarean delivery occurred in 92%, placenta previa/low-lying placenta in 78%, and both in 74%. Antenatal imaging suspected PAS in 91%. Histopathology classified 34% as accreta, 42% as increta and 24% as percreta. Median estimated blood loss was 1800 mL. Packed red-cell transfusion occurred in 63%, massive transfusion (≥4 units) in 27%, and bladder injury in 12%. Percreta had the highest frequency of major blood loss, transfusion and bladder injury.
Conclusion: PAS demonstrates clinically meaningful correlation among antenatal risk factors, imaging, intraoperative severity and histopathological depth of invasion. Standardized pathology reporting complements multidisciplinary antenatal planning and allows clinicopathological audit.