Placenta Accreta Spectrum: Diagnostic Standards, Guideline Concordance and Contemporary Management
DOI:
https://doi.org/10.12775/JEHS.2026.87.67608Keywords
placenta accreta spectrum, abnormally invasive placenta, placenta increta, prenatal diagnosis, ultrasound, cesarean hysterectomy, obstetric hemorrhageAbstract
Background. Placenta accreta spectrum (PAS) encompasses abnormal placental implantation with pathological trophoblastic invasion of the myometrium and, in severe cases, adjacent organs. Rising cesarean delivery rates have increased PAS incidence, making it a major cause of severe obstetric hemorrhage and peripartum hysterectomy. Optimal outcomes depend on accurate prenatal diagnosis and coordinated multidisciplinary management.
Aim. To synthesize contemporary evidence and guideline recommendations on PAS diagnosis, classification, and management, focusing on imaging standards, operative strategies, and models of care.
Material and Methods. A narrative review was based on a targeted search of PubMed/MEDLINE and professional society resources conducted between January 2018 and November 2025. Priority was given to 8 major guideline documents and 5 systematic reviews/meta-analyses; additional observational studies were included for clinical and organizational context.
Results. Guideline documents consistently recommend ultrasound as the first-line test for PAS, with MRI reserved for selected cases requiring additional anatomical detail. Planned cesarean hysterectomy without attempted placental removal remains the standard approach for most invasive PAS. Evidence for conservative management and interventional radiology (IR) adjuncts is inconclusive, and recommendations vary. Centralized care and multidisciplinary team management are repeatedly associated with improved maternal outcomes.
Conclusions. PAS requires standardized diagnostic pathways and coordinated MDT care in specialized centers. Core recommendations align on early prenatal diagnosis (ultrasound with selective MRI) and planned cesarean hysterectomy for most invasive disease. Uncertainty persists for conservative strategies and IR adjuncts; ongoing prospective studies may inform future guideline updates and refine operative pathways, improving maternal safety and outcomes.
References
1. Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. American Journal of Obstetrics and Gynecology. 2018;219(6):B2-B16. doi:10.1016/j.ajog.2018.09.042
2. Jauniaux E, Alfirevic Z, Bhide A, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a. BJOG. 2019;126(1). doi:10.1111/1471-0528.15306
3. Bartels HC, Walsh JM, Ní Mhuircheartaigh R, Brophy D, Moriarty J, Geoghegan T. National Clinical Practice Guideline: Diagnosis and Management of Placenta Accreta Spectrum. National Women and Infants Health Programme and The Institute of Obstetricians and Gynaecologists; 2022. Accessed October 29, 2025. https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/clinical-guidelines/diagnosis-and-management-of-placenta-accreta-spectrum.pdf
4. Giouleka S, Tsakiridis I, Chanioti ER, et al. Placenta Accreta Spectrum: A Comprehensive Review of Guidelines. Obstetrical & Gynecological Survey. 2024;79(6):366-381. doi:10.1097/OGX.0000000000001274
5. Jauniaux E, Ayres‐de‐Campos D, for the FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction,. Intl J Gynecology & Obste. 2018;140(3):261-264. doi:10.1002/ijgo.12406
6. Jauniaux E, Chantraine F, Silver RM, Langhoff‐Roos J, for the FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology,. Intl J Gynecology & Obste. 2018;140(3):265-273. doi:10.1002/ijgo.12407
7. Bhide A. Routine screening for placenta accreta spectrum. Best Practice & Research Clinical Obstetrics & Gynaecology. 2023;90:102392. doi:10.1016/j.bpobgyn.2023.102392
8. Self A, Cavallaro A, Collins SL. Placenta accreta spectrum: imaging and diagnosis. The Obstetric & Gynaecologis. 2025;27(1):15-28. doi:10.1111/tog.12956
9. Maged AM, El-Mazny A, Kamal N, et al. Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):354. doi:10.1186/s12884-023-05675-6
10. Chen Q, Shen K, Wu Y, Wei J, Huang J, Pei C. Advances in Prenatal Diagnosis of Placenta Accreta Spectrum. Medicina. 2025;61(3):392. doi:10.3390/medicina61030392
11. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstetrics & Gynecology. 2018;132(6):e259-e275. doi:10.1097/AOG.0000000000002983
12. Collins SL, Alemdar B, Van Beekhuizen HJ, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. American Journal of Obstetrics and Gynecology. 2019;220(6):511-526. doi:10.1016/j.ajog.2019.02.054
13. Hobson SR, Kingdom JC, Murji A, et al. No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders. Journal of Obstetrics and Gynaecology Canada. 2019;41(7):1035-1049. doi:10.1016/j.jogc.2018.12.004
14. RANZCOG Women’s Health Committee. Placenta Accreta Spectrum (PAS) (C-Obs 20). Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); 2023. Accessed October 30, 2025. https://ranzcog.edu.au/wp-content/uploads/Placenta-Accreta-Spectrum.pdf
15. Hessami K, Kamepalli S, Lombaard HA, Shamshirsaz AA, Belfort MA, Munoz JL. Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2025;232(5):432-452.e3. doi:10.1016/j.ajog.2025.01.030
16. Pinto PV, Freitas G, Vieira RJ, Aryananda RA, Nieto‐Calvache AJ, Palacios‐Jaraquemada JM. Placenta accreta spectrum disorder: A systematic review and meta‐analysis on conservative surgery. Intl J Gynecology & Obste. Published online June 24, 2025:ijgo.70322. doi:10.1002/ijgo.70322
17. Bonanni G, Lopez-Giron MC, Allen L, et al. Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review. JAMA Netw Open. 2025;8(7):e2521909. doi:10.1001/jamanetworkopen.2025.21909
18. Yang R, Zhang L, Sun L, et al. Risk of Placenta Accreta Spectrum Disorder After Prior Non–Cesarean Delivery Uterine Surgery: A Systematic Review and Meta-analysis. Obstetrics & Gynecology. 2025;145(6):628-638. doi:10.1097/AOG.0000000000005824
19. Huras H, Cnota W, Czajkowski K, et al. Placenta accreta spectrum (PAS) — prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines. Ginekol Pol. 2024;95(11):902-920. doi:10.5603/gpl.101422
20. Nieto‐Calvache AJ, Jauniaux E, Fox KA, et al. Are international guideline recommendations for the management of placenta accreta spectrum applicable in low‐ and middle‐income countries? Intl J Gynecology & Obste. 2024;166(3):1047-1056. doi:10.1002/ijgo.15473
21. Jauniaux E, Bhide A, Kennedy A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening,. Intl J Gynecology & Obste. 2018;140(3):274-280. doi:10.1002/ijgo.12408
22. Shainker SA, Coleman B, Timor-Tritsch IE, et al. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. American Journal of Obstetrics and Gynecology. 2021;224(1):B2-B14. doi:10.1016/j.ajog.2020.09.001
23. Hu C, Zhang W, Pei C, et al. Early prediction of placenta accreta spectrum by evaluation of risk factors and ultrasound. Arch Med Sci. Published online October 31, 2024. doi:10.5114/aoms/176673
24. Allen L, Jauniaux E, Hobson S, Papillon‐Smith J, Belfort MA, for the FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,. Intl J Gynecology & Obste. 2018;140(3):281-290. doi:10.1002/ijgo.12409
25. Sentilhes L, Kayem G, Chandraharan E, Palacios‐Jaraquemada J, Jauniaux E, for the FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,. Intl J Gynecology & Obste. 2018;140(3):291-298. doi:10.1002/ijgo.12410
26. Fitzgerald GD, Newton JM, Atasi L, et al. Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care. American Journal of Obstetrics & Gynecology MFM. 2024;6(1):101229. doi:10.1016/j.ajogmf.2023.101229
27. Ghosh A, Lee S, Lim C, Vogelzang RL, Chrisman HB. Placenta Accreta Spectrum: An Overview. Semin intervent Radiol. 2023;40(05):467-471. doi:10.1055/s-0043-1772815
28. Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aryananda R, et al. Evaluation of the topographic classification of placenta accreta spectrum: protocol for an ongoing prospective multicenter study. BMC Pregnancy Childbirth. 2025;25(1):1266. doi:10.1186/s12884-025-08423-0
29. Nieto-Calvache ÁJ, Aryananda RA, Palacios-Jaraquemada JM, et al. One-step conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial. American Journal of Obstetrics & Gynecology MFM. Published online March 2024:101333. doi:10.1016/j.ajogmf.2024.101333
30. The Third Affiliated Hospital of Guangzhou Medical University. Planned Delivery at 37 Versus 36 Weeks in Pregnancies With Placenta Previa and Accreta. National Library of Medicine (US); 2025. Accessed November 26, 2025. https://www.clinicaltrials.gov/study/NCT07025954
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Bartosz Palacz, Natalia Marianna Kubiś, Maria Magdalena Teper, Wiktor Perz , Aleksander Polus, Julia Anna Wrona , Anna Gluzicka, Liwia Olczyk , Jędrzej Piotrowski , Anhelina Korolchuk
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 30
Number of citations: 0
