Conservative management of placenta accreta spectrum disorders: a retrospective cohort study

Placenta Accreta Spectrum Disorders (PASD) are rare but life-threatening obstetric conditions characterized by abnormal placental adherence into or beyond the myometrium, resultant from previous uterine scarring, often rendering placental separation either impossible or associated with a significant risk of massive hemorrhage. As a result, caesarean hysterectomy is commonly performed following delivery, to manage associated complications. With the rising incidence of PASD paralleling the global increase in cesarean deliveries, there is a growing need to investigate and highlight fertility-preserving surgical alternatives. This study aimed to assess the rate of uterine preservation and maternal and fetal outcomes of conservatively managed placenta accreta spectrum disorders (PASD). This retrospective cohort study was performed for conservatively managed patients with PASD at our center between January 2011 and February 2022. Cases were retrieved through operative bookings and codified delivery statistics from the birthing center. Necessary data was then collected through individual chart review. Eleven patients underwent conservative management of PASD, of whom eight were delivered by elective caesarean, two by emergency cesarean, and one was an out-born post-partum transfer. A diagnosis of PASD was suspected antenatally in seven of the patients. Seven patients (63.6%) underwent expectant management, with the placenta left in situ, whereas the other four (36.4%) had extirpative or resective management. A total of 8 patients underwent embolization by interventional radiology immediately following their cesarean, and repeat embolization was performed in two patients. Of the 7 patients managed expectantly, three patients had spontaneous resolution of their residual placenta, three patients underwent interval hysterectomy within a range of 24 to 116 days, while the remaining patient required a curettage. The mean time to resolution of patients who underwent expectant management was 83 days. In this study, 72.7% of conservatively managed cases of PASD avoided hysterectomy following caesarean delivery. While not without risks, conservative management of PASD can be offered to patients wishing to preserve fertility after individualized counselling.