Global Research Trends and Disparities in Cesarean Section-Related Placenta Accreta Spectrum Disorders: A 93-Year Bibliometric Analysis

Placenta accreta spectrum disorders (PASD) complicate 1 in 2500 deliveries globally, with incidence rising parallel to a 31% increase in cesarean section (CS) rates over three decades. This bibliometric analysis maps 93 years (1933-2025) of CS-PASD research to identify collaboration gaps and prioritize solutions focused on equity.

Articles concerning CS and PASD from 1933 to early 2025 were retrieved from the Web of Science Core Collection. A bibliometric analysis was conducted using VOSviewer, CiteSpace, and R- Bibliometrix to evaluate co-authorship networks, institutional collaborations, and keyword co-occurrence patterns.

A total of 758 articles were identified, with an average annual growth rate of 2.64%. Contributions came from 57 countries/regions and involved 3814 authors, with the USA and UK leading in citations. Notable institutions included Sichuan University and University of California System. Key journals included the American Journal of Obstetrics and Gynecology and Obstetrics & Gynecology. Key contributors included Takahashi Hironori (9 articles) and Liu Xinghui (highest collaboration frequency, Total Link Strength (TLS) = 24), with emerging networks centered on Chinese and European institutions. Key keywords included "placenta accreta spectrum", "prior cesarean section", "ultrasound diagnosis", and "Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) guidelines", reflecting major research themes in PASD management. Trends highlighted advancements in diagnostic standardization, such as artificial intelligence (AI)-enhanced placental magnetic resonance imaging (MRI), multidisciplinary care models, and AI-driven risk stratification. Additionally, disparities in global resource allocation underscored the need for equitable healthcare interventions.

Research on CS-PASD has evolved into a multidisciplinary issue, facilitated by advancements in imaging technologies and collaborative efforts. Future investigations should prioritize the integration of AI diagnostics, the development of cost-effective preventive strategies, and the establishment of standardized protocols to enhance maternal safety and mitigate healthcare inequities.