Diagnostic Gold Standard of RPOC with Accreta

Jauniaux, E., Ayres-de-Campos, D., Langhoff-Roos, J., Fox, K. A., & Collins, S. (2019). FIGO
classification for the clinical diagnosis of placenta accreta spectrum disorders,. International Journal
of Gynecology & Obstetrics, 146(1), 20–24. doi:10.1002/ijgo.12761

Histopathology is considered as the gold standard modality recommended to confirm

clinical diagnosis of PAS, but it is often unavailable in adherent

accreta or conservatively managed cases.

Jauniaux, E., Chantraine, F., Silver, R. M., & Langhoff-Roos, J. (2018). FIGO consensus guidelines on
placenta accreta spectrum disorders: Epidemiology,. International Journal of Gynecology &
Obstetrics, 140(3), 265–273. doi:10.1002/ijgo.12407

The use of standardized protocol and terminology for both the clinical diagnosis and
histopathological confirmation of PAS disorders is essential to obtaining new and more accurate
epidemiological data is recommended by FIGO (2018).

Jauniaux, E., Hussein, A. M., Fox, K. A., & Collins, S. L. (2019). New evidence-based diagnostic and
management strategies for placenta accreta spectrum disorders. Best Practice & Research Clinical
Obstetrics & Gynaecology. doi:10.1016/j.bpobgyn.2019.04.006

 The main histopathological criterion used in recent clinical cohorts to confirm the diagnosis
of PAS is the absence of decidual/Nitabuch layer the between the tip of anchoring villi and
superficial myometrium.
 Histopathologic diagnosis of PAS, however, can be very difficult if the surgeon has attempted
to remove the placenta, or impossible in cases of conservative management where the
whole placenta is left in situ. Therefore, collaboration between the surgical team and
pathologists to guide the sampling of the hysterectomy specimen is paramount to obtain
accurate grading and extent of the villous invasion.