Therapeutic Strategies and Obstetric Management in the Treatment of Placenta Accreta

Placenta accreta spectrum (PAS) is a severe obstetric complication associated with increasing cesarean delivery rates and high maternal morbidity and mortality due to hemorrhage, massive transfusion, and hysterectomy. This study synthesizes evidence on therapeutic strategies and obstetric management of PAS through a narrative literature review using the PubMed database. The pathophysiology involves dysfunction of the stromal and endothelial microenvironment of the uterine scar, and although prenatal diagnosis is essential, a substantial proportion of cases remain undetected before delivery. Scheduled delivery between 34 weeks and 35 weeks and 6 days of gestation in multidisciplinary centers reduces emergency interventions. Cesarean hysterectomy remains the established approach, while delayed hysterectomy, conservative surgery, and leaving the placenta in situ are alternatives for selected cases, with placental retention carrying a risk of delayed consumptive coagulopathy. Perioperative hemostatic management includes anemia correction, tranexamic acid, replacement guided by viscoelastic testing, intraoperative blood salvage, and thromboprophylaxis. It is concluded that management should be individualized, considering the extent of invasion, available infrastructure, and specific risks.