Management of Placenta Accreta Spectrum Disorders

Placenta accreta spectrum disorders represent a continuum of abnormal placental attachment that can lead to life-threatening haemorrhage at delivery. The rising incidence parallels increasing rates of caesarean section and other uterine surgery. Early identification through targeted ultrasound features and adjunctive magnetic resonance imaging permits stratification of risk. Management is centred on multidisciplinary planning in specialised centres, with scheduled preterm caesarean hysterectomy often cited as the gold standard to minimise blood loss and maternal morbidity. In select patients wishing to preserve fertility, conservative options—including leaving the placenta in situ with adjuvant uterine artery embolisation or local resection techniques—may be considered, though these approaches carry risks of delayed haemorrhage and infection. Interventional radiology adjuncts, such as prophylactic balloon occlusion of pelvic vessels or the infrarenal aorta, have become integral to reducing intraoperative blood loss. Global disparities in resource availability underscore the need for adaptable algorithms that balance maternal safety with facility capabilities. Clear communication and patient counselling remain essential to align treatment objectives with reproductive goals, ensuring optimal outcomes across diverse settings.

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Management of Placenta Accreta Spectrum Disorders publication trend

The graph below shows the total number of articles in management of placenta accreta spectrum disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Placenta accreta spectrum disorders: A group of conditions characterised by abnormal invasion of placental villi into (accreta), into the myometrium (increta) or through the uterine serosa (percreta).

Placenta previa: A condition in which the placenta partially or wholly covers the internal cervical os, frequently coexisting with invasive attachment.

Uterine artery embolisation: A minimally invasive endovascular procedure that deliberately occludes the uterine arteries to control or prevent obstetric haemorrhage.

Abdominal aortic balloon occlusion: A prophylactic technique in which an inflatable balloon catheter is positioned in the abdominal aorta to temporarily obstruct pelvic blood flow during surgery.

Conservative management: Fertility-preserving strategies for invasive placentation, including placental preservation in situ, local resection, or delayed removal techniques, often combined with endovascular interventions.

References

1. Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study. Human Reproduction Open (2024).
2. Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study. PLOS ONE (2012).
3. Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta. Obstetrics and Gynecology International (2012).
4. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. CardioVascular and Interventional Radiology (2016).
5. Accuracy of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta. PLOS ONE (2014).
6. Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with placenta accreta: a systematic review and meta-analysis. BMC Pregnancy and Childbirth (2019).