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Pathologically diagnosed superficial form of placenta accreta: a comparative analysis with invasive form and asymptomatic muscular adhesion

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Abstract

Pathologically diagnosed placenta accreta is defined as villi adjacent to the myometrium without decidua. It is classified into the superficial (placental accreta vera [PAV]) and deep invasive (placenta increta [PI] and placenta percreta [PP]) types. Data on the clinicopathological characteristics of PAV are limited. Basal plate myometrium (BPMYO) is found in PAV or placentas in asymptomatic women, but its significance is still controversial. This retrospective study aimed to determine the clinicopathological characteristics of pathologically diagnosed PAV and the significance of BPMYO. We reviewed 84 cases of pathologically diagnosed placenta accreta (PAV, 54; PI, 16; and PP, 14), and compared them with controls (i.e., not pathologically diagnosed of any type of placenta accreta, n = 51). Among the PAV cases, the incidence of in vitro fertilization was high, while that of previous cesarean section or placenta previa was low. The incidence of maternal complications was also high in pathologically diagnosed PAV cases, but some PAV were asymptomatic. The rate of prenatal diagnosis of PAV was low, and a high proportion of patients required emergency transportation to central hospitals. Histologically, BPMYO was found in 7 (14%) of controls and 54 (100%) of PAV cases. PAV cases had a higher rate of advanced stages of BPMYO, larger muscle tissue, and more foci than controls. In conclusion, almost PAV is a clinically symptomatic condition but has distinct risk factors and clinical findings from advanced type placenta accreta. Histological evaluation of BPMYO is useful for the diagnosis of PAV.

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Funding

This study was partly supported by grants-in-aid for Scientific Research in Japan (no. 19K07417) from the Ministry of Education, Culture, Sports, Science and Technology, and a grant-in-aid for clinical research from Miyazaki University Hospital.

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Authors and Affiliations

  1. Department of Diagnostic Pathology, Faculty of Medicine Miyazaki University Hospital, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Yuichiro Sato & Murasaki Aman

  2. Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Kazunari Maekawa, Atushi Yamashita & Yujiro Asada

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Yuki Kodama, Kotaro Doi & Hiroshi Sameshima

Authors
  1. Yuichiro Sato
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  2. Murasaki Aman
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  3. Kazunari Maekawa
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  4. Atushi Yamashita
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  5. Yuki Kodama
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  6. Kotaro Doi
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  7. Hiroshi Sameshima
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  8. Yujiro Asada
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Contributions

YS, MA, and KM conceived and designed the study and wrote the manuscript. AY, YS, YK, and YM collected and analyzed the data. HS and YA wrote, edited, and reviewed the manuscript. All authors participated in interpretation of the results and writing of the report and approved the final version submitted. YS takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

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Correspondence to Yuichiro Sato.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study was approved by the Medical Ethics Committee of the Faculty of Medicine at the University of Miyazaki on September 4, 2018 (project number 0–0401).

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This article is part of the Topical collection on Quality in Pathology

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Sato, Y., Aman, M., Maekawa, K. et al. Pathologically diagnosed superficial form of placenta accreta: a comparative analysis with invasive form and asymptomatic muscular adhesion. Virchows Arch 477, 65–71 (2020). https://doi.org/10.1007/s00428-019-02723-5

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  • DOI: https://doi.org/10.1007/s00428-019-02723-5

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