VP46.02: Misclassification of placenta percreta: surgical disruption of the serosa

The traditional teaching regarding placenta accreta spectrum (PAS) is that the placenta invades adjacent structures in placenta percreta. Studies correlating preoperative imaging with postoperative pathology for cases of PAS often show postoperative pictures of placentas protruding from the uterine wall as evidence of “placenta invading through the serosa.” We propose that, in fact, most cases of placenta ‘percreta’ or FIGO Grade 3b are the result of surgical and mechanical disruption of the serosa, not placental invasion. In the process of dividing adhesions and ligating abnormal vessels the thin tissue overlying the abnormally-attached placenta can be disrupted. The final surgical specimen then appears to have placenta invading beyond the uterine serosa. This report shows sequential intraoperative images of a placenta accreta spectrum case in which intraoperative/in situ findings differed from those of the surgical specimen. A large parasitic vessel in the midline of the anterior uterus is apparent in each photograph. Initially, the serosa on the right was intact. During the course of the hysterectomy, the thin uterine serosa was disrupted by a surgical clamp, allowing placenta to protrude laterally. The explanted uterus when submitted to pathology appears to to have right-sided placental protrusion with disruption of the uterine serosa. This case could easily be misclassified as “percreta” or “PAS with serosal invasion”. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.