Placenta Accreta Spectrum: A Narrative Review of Clinical Management, Contemporary Innovations, And Global Challenges

Area of Science:

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

Background:

• Placenta accreta spectrum (PAS) is a severe obstetric complication with increasing incidence globally.
• Existing clinical guidelines for PAS often lack applicability in resource-limited settings.
• There's a need to integrate advanced diagnostic and management strategies into diverse healthcare environments.

Purpose of the Study:

• To comprehensively review the evolving clinical landscape of PAS.
• To evaluate diagnostic advancements and multidisciplinary management frameworks for PAS.
• To assess the integration of emerging technologies in diverse healthcare settings.

Main Methods:

• A narrative review of peer-reviewed publications, guidelines, and clinical studies.
• Searches conducted in major databases (PubMed, SCOPUS, Web of Science, Google Scholar).
• Data synthesis focused on diagnostics, management, and outcomes, including LMIC context.

Main Results:

• PAS incidence is rising due to increased cesarean section rates.
• Key diagnostic signs like intracervical lakes and the "rail sign" improve prenatal identification.
• Multidisciplinary care and intraoperative adjuncts improve outcomes, but severe morbidity persists in low-resource settings.

Conclusions:

• Timely prenatal detection and coordinated care are crucial for optimizing PAS outcomes.
• Advances in imaging and real-time assessments aid surgical planning and risk stratification.
• Standardized frameworks and expanded access to multidisciplinary care are essential, particularly in low-resource settings.