Management Strategies and Surgical Interventions of Placenta Accreta Spectrum: A Comprehensive Review

Abstract

Placenta accreta spectrum (PAS) is an increasingly significant obstetric complication associated with rising cesarean delivery rates and advanced maternal age. It is characterized by abnormal placental adherence or invasion into the uterine wall and is associated with severe maternal morbidity and mortality, particularly in advanced forms such as placenta percreta. This review was conducted to synthesize current evidence on the pathophysiology, diagnosis, and management of PAS. A comprehensive literature search was performed using PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2025. Relevant articles, including original studies, systematic reviews, meta-analyses, and clinical guidelines, were selected based on predefined inclusion criteria and analyzed qualitatively. The findings indicate that early antenatal diagnosis using ultrasound and magnetic resonance imaging (MRI) plays a critical role in improving maternal and fetal outcomes. While cesarean hysterectomy remains the standard treatment for PAS, conservative and fertility-preserving approaches such as one-step conservative surgery and leaving the placenta in situ are emerging as viable alternatives in selected cases. However, these approaches are associated with variable outcomes and require careful patient selection and multidisciplinary expertise. Advances in imaging techniques, perioperative management, and the integration of telemedicine in resource-limited settings have further contributed to improved clinical decision-making and outcomes. In conclusion, effective management of PAS requires early diagnosis, standardized classification, and a multidisciplinary approach tailored to disease severity and patient needs. Although significant progress has been made, further research is needed to refine conservative strategies, improve diagnostic accuracy, and develop standardized management protocols to enhance maternal and neonatal outcomes globally.