Outcomes of subsequent pregnancies following modified one-step conservative uterine surgery (MOSCUS) in the management of placenta accreta spectrum: Two case reports and a narrative review of the literature

Cesarean hysterectomy is a common management approach for placenta accreta spectrum. While conservative uterine management can preserve fertility, outcome data remain limited. This article reports the long-term results of modified one-step conservative uterine surgery (MOSCUS) in two cases of placenta accreta spectrum and reviews the literature on the outcomes of subsequent pregnancies after conservative management of the condition. Two women with a history of placenta accreta spectrum managed with MOSCUS attended a tertiary referral hospital in southern Vietnam with term and near-term pregnancies. The pregnancy outcomes were favorable with elective cesarean delivery. Neither uterine rupture nor recurrent placenta accreta spectrum was observed. The low uterine segment of the myometrial layer was 1-1.5 cm in thickness. The mothers and neonates were discharged uneventfully. The data relating to the subsequent pregnancy outcomes after conservative management reported in the literature spanning 2020-2025 are limited and heterogeneous. Commonly, the materno-fetal outcomes are favorable. The recurrence of placenta accreta spectrum in late pregnancy ranges from 5.5 % to 22.7 %. The major concerns are the increased rate of cesarean section and postpartum hemorrhage. In conclusion, the MOSCUS is a promising method that preserves fertility. A well-resourced antenatal care system with a multidisciplinary team is needed to manage these high-risk pregnancies. Further data are required to strengthen these findings.