FIGO Grading (Placenta Accreta Spectrum)

What the result means

Clinical, not histological

FIGO grades what the surgeon sees at operation, deliberately, so the grade holds without pathology. A later histological report may not match it.

Grade 1

No distension over the placental bed, no tissue through the uterine surface, little or no neovascularity; the placenta will not separate and manual removal brings heavy bleeding.

Grade 2

Bluish or purple color, distension - the placental bulge - and significant neovascularity; the dimple sign on cord traction; still NO invasion through the uterine surface.

Grade 3a

Placental tissue invading through the serosa, no other organ involved, with a clear surgical plane between bladder and uterus.

Grade 3b

Invasion into the bladder wall or urothelium, no other organ, with no clear surgical plane between bladder and uterus.

Grade 3c

Invasion into the broad ligament, vaginal wall, pelvic sidewall or any other pelvic organ, with or without bladder involvement.

3c outranks 3b

Parametrial or other pelvic involvement settles the grade whether or not the bladder is involved, so finding bladder invasion does not end the question.

The 3a/3b line

The discriminator is the SURGICAL PLANE between bladder and uterus, not how close the placenta appears to the bladder.