Current state of the placenta accreta spectrum issue: prospects for organ-preserving treatment

Abstract

Introduction. Placenta accreta spectrum (PAS) is the preferred term approved by most international organizations that refers to the range of pathologic adherence of the placenta. PAS is a serious problem with incidence rate of 1/272 in-labor women. Today, peripartal hysterectomy is considered as the generally accepted global practice for PAS management, however, this approach is related to high level of maternal mortality and the impossibility of pregnancy in the future.Aim: to analyze publications on the available methods for PAS diagnostics and management by highlighting organ-preserving treatment including assessment of relevant risks and benefits compared with other methods as well as prospects for patients.Materials and Methods. Research papers were searched for in the databases eLibrary, PubMed and Google Scholar released until August 2024. The following search queries were used: "placenta accreta spectrum", "PAS", "PAS and organ-preserving treatment", "PAS and peripartum hysterectomy", "PAS and organ-preserving management". The selection of publications was carried out in accordance with the recommendations of PRISMA initiative that allowed to analyze 75 studies included in the review.Results. Organ-preserving PAS treatment is a reasonable alternative to peripartal hysterectomy, because it provides better results with lower risk to maternal health. It is worth noting that each of these methods has own unique features. For instance, organ-preserving treatment may last longer to achieve a desired result, but at the same time it can reduce a risk of complications and improve a woman's quality of life in the long term. Along with this, peripartal hysterectomy may be more effective in the short term, but it is associated with a higher risk of complications.Conclusion. A doctor should provide a woman with all the necessary information about the risks and benefits of each method, as well as help a woman make an informed decision based on her individual needs and preferences. Organ-preserving PAS treatment contributing to preserve fertility offers a better quality of life with lower risk to maternal health. Ultimately, a choice between peripartal hysterectomy and organ-preserving treatment depends on a specific situation as well as woman's state of health.