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Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review
Giulia Bonanni1,2, Maria C Lopez-Giron3, Lisa Allen4,5
1Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Obstetrical & Gynecological Survey
|January 20, 2026
Summary
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.
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.
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