Review Article
Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers
Table 1
Summary of published studies examining serum biomarkers for PAS.
| | Marker | Study | Total cases | Control cases (type) | Year | Median MoM (PAS) | Median MoM (control) | Trimester | PAS histological confirmation | Comment |
| | PAPP-A | Desai et al. [69] | 82 | 66 (previa) | 2014 | 1.68 | 0.98 | First | Yes | Assayed 81–95 days GA | | Thompson et al. [58] | 516 | 344 (normal)
155 (previa) | 2015 | 1.22 | 1.01 | First | Yes | Assayed 11–13 weeks GA | | Lyell et al. [70] | 736 | 699 (previa) | 2015 | N/A | N/A | First | No | Assayed 10–13 + 6 weeks GA | | Büke et al. [82] | 88 | 69 (previa) | 2018 | 1.20 | 0.865 | First | Yes | N/A | | β-HCG | Hung et al. [80] | 9349 | 9321 (nonaccreta) | 1999 | 1.7+/−1.1 | 1.2+/−1.1 | Second | 2 of 28 (remainder clinical diagnosis) | Assayed 14–22 weeks GA | | Dreux et al. [81] | 69 | 552 (randomly selected routine age-matched maternal serum samples) | 2012 | 1.50 | 1.00 | Second | 35 of 69 had surgical treatment—unclear number having histological confirmation | | | Desai et al. [69] | 82 | 66 (previa) | 2014 | 1.00 | 1.01 | Second | Yes | | | Thompson et al. [58] | 516 | 344 (normal)
155 (previa) | 2015 | 0.81 | 1.04 | First | Yes | Assayed 11–13 weeks GA | | Büke et al. [82] | 88 | 69 (previa) | 2018 | 1.42 | 0.93 | First | Yes | N/A | | AFP | Zelop et al. [57] | 25 | 14 (previa) | 1992 | 2.3–5.5 | Normal range | Second | Yes | Only 45% of PAS had elevated AFP (>2.0 MoM) | | Kupferminc et al. [99] | 44 | 24 (emergency caesarean hyster; no PAS on histopath) | 1993 | 2.7–40.3 | Normal range | Second | Yes | Only 45% of PAS had elevated AFP. (≥2.5 MoM) | | Hung et al. [80] | 9349 | 9321 (nonaccreta) | 1999 | 1.7+/−1.0 | 1.1+/−0.4 | Second | 2 of 28 (remainder clinical diagnosis) | Assayed 14–22 weeks GA | | Dreux et al. [81]l | 69 | 552 (randomly selected routine age-matched maternal serum samples) | 2012 | 1.23 | 0.99 | Second | 35 of 69 had surgical treatment—unclear number having histological confirmation | | | Lyell et al. [70] | 736 | 699 (previa) | 2015 | N/A | N/A | Second | No | Assayed 15–20 weeks | | Oztas et al. [95] | 316 | 204 (previa) + 61 (PAS managed conservatively) | 2016 | 1.28+/− | 0.87+/−0.37 | Second | Yes | Assay 16–20 weeks. Cases = PAS requiring hysterectomy |
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PAPPA: pregnancy-associated plasma protein A; GA: gestational age; AFP: alpha fetal profile; β-HCG: human chorionic gonadotropin beta subunit; PAS: placenta accreta syndrome; MoM: multiples of the median.
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