Placenta accreta spectrum: management update

Key content Surgical complexity in placenta accreta spectrum (PAS) results from progressive uterine remodelling, alongside placental location, vascularity and adhesions. PAS is an iatrogenic disease. Any process that disrupts the endometrium increases the risk. Decisions for management of PAS patients should be taken by expert multidisciplinary teams in specialised centres. The surgical management options include caesarean hysterectomy and uterine conservation. Experience with adjuvant techniques improves outcomes. Learning objectives To understand the pathophysiology of PAS and its role in correlating sonographic, intraoperative findings and histopathological diagnoses to enhance its diagnosis and management. Explore various surgical management options and adjuvant techniques to improve surgical outcomes during PAS surgery. Identify strategies to improve training for future specialists in PAS management. Ethical issues Raise public awareness and enhance inclusion of PAS information in consent forms for elective caesarean deliveries, as many patients are unaware of PAS until diagnosed. Ensure appropriate sonographic and surgical expertise in PAS centres to choose safely between uterine conservation and caesarean‐hysterectomy, aiming to reduce morbidity and mortality.