Maternal Characteristics and Histopathological Features of Placenta Accreta Spectrum in Dr. Hasan Sadikin General Hospital Bandung, Period 2015–2020

Yuktiana Kharisma, Hasrayati Agustina, Sri Suryanti, Birgitta Maria Dewayani, Bethy Suryawati Hernowo


Background: The placenta accreta spectrum (PAS) incidence has inclined today. The PAS is divided into three histopathological classifications, including accreta, increta, and percreta, associated with maternal, fetal morbidity, and mortality. This study aimed to explore the maternal characteristics and histopathological features in PAS at Dr. Hasan Sadikin General Hospital Bandung.

Methods: This descriptive observational study involved 135 cases from January 2015–December 2020 at Dr. Hasan Sadikin General Hospital that met the inclusion criteria. The PAS histopathological classification was evaluated based on maternal characteristics such as age, parity, cesarean section (CS), and miscarriage.

Results: The incidence of placenta accreta from 2015 to 2020 was 37.0%, whereas increta was 43.4%, followed by percreta at 19.3%. The maternal age of placenta accreta and increta mainly occurred at the age of 30–34 years with the prevalence of 40% and 46%, respectively, whereas percreta was aged 35–39 yo (27%). Most parities in placenta accreta, increta, percreta were three. Interestingly, 93% of cases had a CS history. Furthermore, the miscarriage history for accreta was 18%, increta 29% and percreta 38%.

Conclusion: The highest incidence of PAS in Dr. Hasan Sadikin General Hospital is placenta increta, which mainly occurs at the age of 30–34 years. Almost all PAS patients have a history of CS; however, most of the patients do not have a miscarriage history.


Characteristics, histopathological features, increta, percreta, placenta accreta spectrum

Full Text:



Silver RM, Lyell DJ. Placenta accreta spectrum. In: Queenan JT, Spong CY, Lockwood CJ, editors. Protocols for high‐risk pregnancies: an evidence‐based approach. 7th Ed. Hoboken, NJ: Wiley-Blacwell; 2021. p. 571–80.

Belfort MA, Shamshirsaz AA, Fox KA. The diagnosis and management of morbidly adherent placenta. Semin Perinatol. 2018;42(1):49.

Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int. 2012;2012:873929.

Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140(3):265–73.

Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75–87.

Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733–42.

Hartiningrum I, Fitriyah N. Bayi berat lahir rendah (BBLR) di Provinsi Jawa Timur tahun 2012–2016. J Biometrika Kependudukan. 2018;7(2):97–104.

Farquhar CM, Li Z, Lensen S, McLintock C, Pollock W, Peek MJ, et al. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study. BMJ Open. 2017;7(10):e017713.

Balayla J, Bondarenko HD. Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med. 2013;41(2):141–9.

Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Cahill AG, Beigi R, Heine RP, Silver RM, et al. Placenta accreta spectrum. Am J Obstet Gynecol. 2018;219(6):B2–16.

El Gelany S, Mosbeh MH, Ibrahim EM, Mohammed M, Khalifa EM, Abdelhakium AK, et al. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):313.

Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand. 2013;92(4):457–60.

Bheeshma B, Nithyananda B, Fatima S, Anjum F. A retrospective study of placenta cretas: a 4 year experience at Modern Government Maternity Hospital, Hyderabad. IAIM. 2017; 4(5):31–6.

Kyozuka H, Yamaguchi A, Suzuki D, Fujimori K, Hosoya M, Yasumura S, et al. Risk factors for placenta accreta spectrum: findings from the Japan environment and Children’s study. BMC Pregnancy Childbirth. 2019;19(1):447.

Baldwin HJ, Patterson JA, Nippita TA, Torvaldsen S, Ibiebele I, Simpson JM, et al. Maternal and neonatal outcomes following abnormally invasive placenta: a population-based record linkage study. Acta Obstet Gynecol Scand. 2017;96(11):1373–81.

Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33(4):244–51.

Badr DA, Al Hassan J, Wehbe GS, Ramadan MK. Uterine body placenta accreta spectrum: a detailed literature review. Placenta. 2020;95:44–52.

Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(1):27–36.

Maybin JA, Hirani N, Brown P, Jabbour HN, Critchley HO. The regulation of vascular endothelial growth factor by hypoxia and prostaglandin F2α during human endometrial repair. J Clin Endocrinol Metab. 2011;96(8):2475–83.

Tsuzuki T, Okada H, Cho H, Tsuji S, Nishigaki A, Yasuda K, et al. Hypoxic stress simultaneously stimulates vascular endothelial growth factor via hypoxia-inducible factor-1α and inhibits stromal cell-derived factor-1 in human endometrial stromal cells. Hum Reprod. 2012;27(2):523–30.


Article Metrics

Abstract view : 465 times
PDF - 466 times

 This Journal indexed by




Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats