Reconsidering the Role of Attempted Uterine Conservation by Intentional Placental Retention in Placenta Accreta Spectrum

Placenta accreta spectrum (PAS) is a rare complication associated with significant maternal morbidity and mortality. Historically, 2 surgical approaches emerged in the management of PAS, namely, hysterectomy or leaving the placenta in situ, hoping to avoid surgical morbidity and preserve future fertility. In this article, we argue that the risks of intentional placental retention for managing PAS outweigh the benefits, leaving patients unnecessarily exposed to the ongoing risk of hemorrhage and hysterectomy, with prolonged intensive follow-up required. Furthermore, histopathologic findings for these cases are inherently lacking, further limiting our ability to fully understand the underlying etiology of these cases.