# Surgical Management of Placenta Accreta Spectrum: A Five-Year Institutional Experience

## TL;DR

This paper examines surgical outcomes for placenta accreta over five years, showing that planned surgeries improve maternal safety compared to emergency procedures.

## Contribution

The study provides new institutional data on PAS surgical management, emphasizing the importance of early diagnosis and planned interventions.

## Key findings

- Emergency surgery was associated with significantly higher blood loss compared to planned procedures.
- Planned surgeries with antenatal diagnosis improve maternal outcomes through better resource readiness and team coordination.

## Abstract

Background: Surgical management of placenta accreta spectrum (PAS), particularly in emergency settings, poses significant risks. Although PAS is being encountered more frequently, there is still limited institutional data available to guide management. This study was aimed at evaluating the surgical outcomes in a tertiary care institution over five years and contributing to the growing body of evidence that guides the surgical management of PAS.

Methods: A retrospective review was conducted on 18 surgically managed PAS cases from April 2020 to March 2025. Demographics, intraoperative parameters, and maternal outcomes were analyzed. Comparative and regression analyses were performed.

Results: Mean maternal age was 30.6 years. Mean estimated blood loss (EBL)was 1822 ml (range 600-3600 ml), and mean operating time was 85.3 minutes (range 40-170 minutes). Emergency surgery was significantly associated with higher blood loss (p = 0.0002). Regression analysis revealed that emergency surgery was associated with more significant blood loss (β = 1,918 ml, p = 0.001).

Conclusion: Early antenatal diagnosis and planned surgeries are key to improving maternal outcomes. Multidisciplinary teams and preparedness are critical for optimal results. Our five-year institutional experience demonstrates that surgical management of PAS remains a high-risk intervention. Planned surgical approaches with antenatal diagnosis significantly improve outcomes by enabling resource readiness and effective team coordination. Emergency procedures, by contrast, are fraught with complications, further reinforcing the necessity for early risk identification and referral to equipped centers.