Conservative Management of Placenta Accreta Spectrum: A Modern Treatment Alternative to Cesarean-Hysterectomy

This review summarizes conservative management of placenta accreta spectrum (PAS) disorders, also termed leaving the placenta in situ. The discussion includes clinical considerations in deciding between cesarean-hysterectomy and conservative management, as well as intrapartum and postpartum conservative management techniques.

A growing body of evidence supports conservative management of PAS for both reduction of morbidity and uterine preservation. Compared to cesarean-hysterectomy, conservative management of PAS is associated with lower maternal morbidity, including blood loss, transfusion, operative injury, and intensive care unit admission. However, intensive, long-term postpartum surveillance is required to monitor for complications such as infection, bleeding, and coagulopathy. These risks should be balanced with an individual’s risk profile and personal desires provided by a multidisciplinary, experienced PAS care team.

We provide recommendations for patient-centered care planning, resource requirements, and conservative management techniques. Conservative management of PAS is a feasible alternative to cesarean-hysterectomy, and options for management should be discussed with all pregnant individuals with PAS.