Management of Placenta Accreta Spectrum

Abstract

Background: Placenta accreta spectrum (PAS) is a severe obstetric condition characterized by abnormal placental adherence or invasion into the uterine wall. The incidence of PAS has increased in recent years, largely due to rising cesarean delivery rates. This condition is associated with significant maternal morbidity and mortality, mainly due to massive obstetric hemorrhage and surgical complications. Early diagnosis, multidisciplinary management, and careful surgical planning are essential to improve maternal outcomes. Various management strategies have been described, including cesarean hysterectomy, conservative uterine-preserving approaches, and adjunctive measures to reduce intraoperative blood loss. Cesarean hysterectomy with the placenta left in situ remains the standard treatment in most cases; however, conservative techniques such as expectant management, resective surgery, and the Triple-P procedure may be considered in selected patients wishing to preserve fertility. Blood conservation strategies and multidisciplinary team involvement play a crucial role in optimizing outcomes. This review discusses current evidence regarding the diagnosis, surgical and conservative management strategies, and maternal outcomes of placenta accreta spectrum disorders.