Placenta Accreta Spectrum: Diagnostic Challenges and Management Strategies

TL;DR

This review discusses the challenges in diagnosing and managing placenta accreta spectrum, a serious pregnancy condition linked to high maternal risks.

Contribution

The paper provides updated clinical insights and highlights gaps in evidence for managing placenta accreta spectrum.

Findings

Placenta accreta spectrum is linked to maternal mortality rates up to 7% and significant long-term psychological effects.

Planned cesarean hysterectomy is recommended as the safest treatment for most cases.

Standardized diagnostic criteria and multidisciplinary care are needed to improve outcomes.

Abstract

This narrative review presents an updated overview of the etiology, pathophysiology, diagnostic approaches, and management strategies for Placenta Accreta Spectrum (PAS), with emphasis on clinical implications and current gaps in evidence. PAS is associated with substantial maternal morbidity and mortality, with reported maternal mortality rates approaching 7%. Affected patients often experience prolonged hospitalization, repeated surgical interventions, and long-term psychological and emotional consequences. The development of PAS is primarily attributed to impaired decidualization in areas of uterine scarring, resulting in abnormal adherence or invasion of chorionic villi into the myometrium. Optimal outcomes in high-risk pregnancies depend on early antenatal identification using characteristic pathological and imaging findings. Current evidence supports planned cesarean hysterectomy as the safest and most definitive treatment for most patients, whereas conservative and uterus-preserving approaches should be reserved for carefully selected cases managed in specialized centers. Further progress in PAS management requires standardized diagnostic criteria, prospective evaluation of conservative strategies, and improved access to multidisciplinary expertise.

Figures