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Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review
Giulia Bonanni1,2, Maria C Lopez-Giron3, Lisa Allen4,5
1Fetal Care and Surgery Center, Division of Fetal Medicine and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Network Open
|July 18, 2025
Summary
Clinical practice guidelines for placenta accreta spectrum (PAS) show consensus on diagnosis and antenatal management but lack guidance on cesarean hysterectomy and conservative treatments, highlighting a need for more research.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Specialties
Background:
- Placenta accreta spectrum (PAS) is a life-threatening obstetric complication requiring multidisciplinary management.
- Standardized protocols and consensus are crucial for optimizing outcomes and mitigating risks in PAS.
- Effective management necessitates collaboration among obstetrics, maternal-fetal medicine, and surgical/medical specialists.
Purpose of the Study:
- To systematically review clinical practice guidelines for PAS.
- To identify areas of consensus and gaps in guidance for PAS management.
- To include guidelines from both high-income and low- to middle-income countries (LMICs).
Main Methods:
- A comprehensive search of PubMed, GIN Library, and ECRI Guidelines Trust was conducted for PAS guidelines (2014-2024).
- Two independent reviewers screened guidelines, with conflicts resolved by expert panel consensus.
- Agreement scores were categorized as high agreement (≥75%), poor consensus (<50%), or high insufficient evidence (≥50%).
Main Results:
- Fourteen guidelines were included, showing high agreement on specialized expertise, antenatal management, diagnosis, and epidemiology.
- Poor consensus and insufficient evidence were found in cesarean hysterectomy, conservative techniques, and fertility counseling.
- Significant gaps exist in recommendations for hemorrhage management, postnatal care, iron supplementation, and thromboembolism prevention, with limited focus on LMICs.
Conclusions:
- Significant discrepancies and insufficient evidence exist in current PAS clinical practice guidelines.
- There is an urgent need for further research and quality measures to standardize PAS care and improve patient outcomes.
- Tailored guidance for LMICs is critical, addressing resource constraints and unique clinical access challenges.
