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Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review.

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Placenta accreta spectrum (PAS) management shows consensus in diagnosis and antenatal care but lacks agreement on surgical strategies. Further research is needed for standardized, global PAS care, especially in low-income countries.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Surgical Management

Background:

  • Placenta accreta spectrum (PAS) is a severe obstetric complication with high risks of hemorrhage and mortality.
  • Management is complex, requiring multidisciplinary care, especially for invasive cases.
  • Variations in clinical practice guidelines (CPGs) exist globally, necessitating standardization.

Purpose of the Study:

  • To systematically review national and international CPGs for PAS over the last decade.
  • To identify areas of agreement, disagreement, and insufficient evidence in PAS care.
  • To provide a roadmap for improving global PAS management.

Main Methods:

  • A comprehensive search of databases (PubMed, GIN, ECRI) and society websites for PAS CPGs.
  • Two reviewers extracted recommendations, followed by two rounds of expert panel feedback and consensus evaluation.
  • Guidelines were categorized by agreement level and topic (epidemiology, diagnosis, management, postnatal care).

Main Results:

  • 18 articles from 14 societies were analyzed, showing high agreement on risk factors (e.g., cesarean history), diagnostic principles (ultrasound), and antenatal management.
  • Strong consensus exists for specialized care, multidisciplinary teams, and planned delivery at 34-35 weeks.
  • Substantial variability and limited evidence were found in surgical/peripartum recommendations (incision, balloon occlusion, anesthesia, conservative strategies), with only one guideline addressing low- and middle-income countries.

Conclusions:

  • While diagnosis and antenatal care for PAS have broad consensus, surgical and peripartum management require further investigation and standardization.
  • There is a critical need for comparative research and international collaboration to address management gaps, particularly for resource-limited settings.
  • Developing standardized guidelines for PAS is essential for reducing maternal morbidity and mortality worldwide.