<p>Placenta accreta spectrum (PAS) is a serious obstetric complication, characterized by the placenta accreta and increta to the uterine wall, which fails to detach spontaneously from the uterine following childbirth, potentially resulting in severe hemorrhage and additional complications. The incidence of PAS is increasing in the world, which is mainly attributed to a global escalation in cesarean section rates, underscoring the critical need to elucidate its molecular pathogenesis and to devise efficacious clinical interventions. Recent studies have identified novel molecular mechanisms that have significantly enhanced our comprehension of disease pathophysiology and informed predictive and therapeutic strategies. Here, we review the principal molecular pathogenesis of PAS, explore the potential translation of these findings into clinical applications, and assess the impact of emerging technologies on advancing research in this domain.</p>