Telemedicine-assisted conservative management of placenta accreta spectrum: a case series from a tertiary center in Lithuania

Placenta accreta spectrum (PAS) is a severe obstetric disorder that requires extensive resources and multidisciplinary expertise. In many European centers, low case numbers and the absence of structured training programs limit opportunities to adopt conservative surgical techniques. At present, there is no consensus on the optimal management of PAS. We describe the first experience with uterine-sparing surgery for PAS in a Lithuanian tertiary center, developed through collaboration with Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili (Cali, Colombia). Between April and September 2024, four women with antenatally suspected PAS (two increta, two accreta) were treated with one-step conservative surgery (OSCS). Teleconsultation supported each stage of care, including ultrasound review, joint surgical planning, intraoperative assistance, and postoperative debriefing. All four patients recovered without major complications, and neonatal outcomes were favourable. For comparison, outcomes from nine women managed with cesarean hysterectomy between 2022 and 2023 were reviewed. This case series demonstrates that uterine-sparing surgery can be safely introduced in a low-volume setting with structured teleconsultation support. International collaboration provides a practical framework for surgical training and may facilitate broader adoption of conservative PAS management. Placenta accreta spectrum (PAS) is a dangerous pregnancy complication where the placenta attaches too deeply to the uterus. It can cause heavy bleeding at birth, and in many hospitals, the usual treatment is hysterectomy (removal of the uterus), which ends the chance of future pregnancies. In this report, doctors in Lithuania collaborated with a team of international experts in Colombia, utilizing teleconsultation to share ultrasound images, plan surgeries together, and receive live support during operations. Four women with PAS were treated with uterus-preserving surgery instead of hysterectomy, and both mothers and babies had good outcomes. This experience shows that international collaboration through telemedicine can help hospitals safely adopt new surgical techniques, giving women with PAS a chance to avoid hysterectomy and preserve fertility when carefully selected and supported.