Placenta Accreta: Prevention and Current Surgical Strategies

Placenta accreta is an obstetric condition characterized by the abnormal invasion of chorionic villi into the uterine wall, which can result in severe hemorrhage and significant maternal complications.Its incidence has been increasing, largely due to the higher rate of previous cesarean deliveries.Prevention involves identifying risk factors such as low placentation over a uterine scar and a history of uterine surgery and performing detailed ultrasonographic monitoring in the second and third trimesters.The ideal surgical strategy requires multidisciplinary planning, with blood products reserved and teams from Anesthesiology, Surgery, and Hemotherapy on standby, preferably in a reference center.Surgical options include classic cesarean hysterectomy, hysterectomy after placental separation, and conservative techniques for uterine preservation, such as selective occlusion of uterine or internal iliac arteries, hemostatic sutures, and intrauterine balloon tamponade.Studies demonstrate that conservative management can reduce hysterectomy rates and improve reproductive outcomes but is associated with a higher risk of delayed hemorrhage and reintervention.Prophylactic placement of balloon catheters in the internal iliac arteries has been shown to decrease intraoperative blood loss but requires technical expertise and interventional radiology support.Training programs and standardized protocols are essential for optimizing management.In conclusion, the combination of early diagnosis, multidisciplinary planning, and individualized surgical technique selection enhances maternal safety and, when possible, preserves fertility.