Clinical insights into placenta accreta spectrum: a comprehensive review.

Abstract

Placenta accreta spectrum (PAS) is defined by abnormal placental adherence or invasion into the myometrium or adjacent organs and is a leading cause of massive obstetric hemorrhage. Its global incidence is increasing due to rising cesarean delivery rates, uterine surgeries, and the use of assisted reproductive technologies. This review summarizes the current knowledge regarding PAS, including its pathophysiology, risk factors, diagnostic methods, treatment options, and pregnancy outcomes after conservative management. The underlying pathogenesis is related to defective decidualization at the endometrial-myometrial interface, which is commonly associated with uterine scarring. Prenatal diagnosis relies on a thorough clinical history and imaging tools such as ultrasound and magnetic resonance imaging. Management strategies depend on fertility preservation goals and range from hysterectomy to conservative approaches such as leaving the placenta in situ. Effective management requires early risk identification, prenatal screening, referral to specialized centers, and delivery planning by a multidisciplinary team. Despite recent advances in imaging and surgical techniques, PAS remains the leading cause of maternal mortality and morbidity worldwide. There is a critical need for multicenter studies, standardized risk stratification tools, and long-term followup studies to optimize care and improve maternal and reproductive outcomes.