Placenta Accreta Spectrum: Diagnostic Challenges and Management Strategies

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Placenta Accreta Spectrum (PAS) presents a significant threat to maternal health, associated with high rates of morbidity and mortality.
• Impaired decidualization in uterine scars is the primary cause of abnormal placental adherence or invasion.
• Existing evidence highlights the need for updated management strategies and diagnostic criteria.

Purpose of the Study:

• To provide a comprehensive review of the etiology, pathophysiology, diagnosis, and management of Placenta Accreta Spectrum (PAS).
• To emphasize clinical implications and identify current gaps in evidence for PAS management.
• To update healthcare providers on the latest approaches to high-risk pregnancies involving PAS.

Main Methods:

• Narrative review of existing literature on Placenta Accreta Spectrum (PAS).
• Analysis of diagnostic approaches, including pathological and imaging findings.
• Evaluation of current management strategies, encompassing surgical and conservative options.

Main Results:

• PAS significantly increases maternal morbidity and mortality, with rates nearing 7%.
• Early antenatal identification through characteristic findings is crucial for optimal outcomes.
• Planned cesarean hysterectomy is the recommended treatment for most PAS cases, while conservative approaches require careful selection and specialized management.

Conclusions:

• Effective management of PAS hinges on early diagnosis and a multidisciplinary approach.
• Standardized diagnostic criteria and prospective evaluation of conservative strategies are needed.
• Improved access to specialized centers and expertise is essential for advancing PAS care and improving patient outcomes.