Placenta accreta spectrum: clinical and radiological follow-up after conservative management and maternal
S Zullino1, E Romani1, S Ottanelli1
1Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy.
Background:
The prevalence of placenta accreta spectrum (PAS) has increased due to higher cesarean section rates and evolving risk factors, such as advanced maternal age. Conservative techniques offer alternatives to cesarean hysterectomy, aiming to reduce adverse outcomes and preserve fertility. However, data on maternal short- and long-term complications, particularly when placental residue is left in utero, remain limited, and follow-up protocols are unclear.
Objectives:
This study evaluates the safety and effectiveness of a conservative strategy. For patients with placental residue, it assesses resolution through clinical and radiological follow-up and related maternal outcomes.
Methods:
A retrospective observational study was conducted at Careggi University Hospital, Florence, from 2019 to 2024. Of 45 PAS patients, 41 (91%) underwent conservative management. Among them, 23/41 had placental residue and underwent follow-up, while 18/41 had complete placental removal.
Results:
The conservative management success rate was 92.6%. In 20/23 cases (86.9%) with placental residue, complete resorption occurred without major complications. Only 3/41 (7.3%) cases required delayed hysterectomy.
Conclusions:
Conservative management is a feasible option for most PAS cases, but an experienced multidisciplinary team and careful patient selection are essential for optimal outcomes. When an adherent placental residue is left in utero, accurate clinical and radiological follow-up should be performed until complete resolution, which occurs in most cases.
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