What is the risk of PAS with multiple prior cesareans?

PAS risk with anterior previa: 1 prior CS = 3-4%; 2 = 11%; 3 = 40%; 4 = 61%; 5+ = 67%. Without previa: 1 prior CS = 0.03%; 3+ = 0.57%. Prior myomectomy and uterine curettage also increase PAS risk.

What ultrasound features suggest PAS?

Loss of retroplacental clear space, placental lacunae (Swiss cheese appearance), irregular bladder wall, bridging vessels crossing from placenta to bladder. MRI is adjunct for posterior PAS and invasion depth.

What is the management of PAS?

Planned delivery at 34-36 weeks at a level III/IV center with accreta team. Hysterectomy at time of cesarean is definitive (peripartum hysterectomy rate >90%). Conservative management (leaving placenta in situ) in highly selected cases.

Placenta Accreta Spectrum Diagnosis and Risk Score

Calculate placenta accreta spectrum (PAS) risk using prior cesarean count, placenta previa, prior uterine surgery, and ultrasound findings. PAS risk rises to 40-67% with anterior previa and 3+ prior cesareans.

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Placenta Previa Distance

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