Conservative approach: Intentional retention of the placenta

A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum

“…Postpartum complications demanded emergent interventions in conservatively managed women, therefore ongoing vigilance and the ability to perform emergent hysterectomy remains a critical skill, even in centers where conservative management is routinely carried out. 18 As expected, placenta previa and placenta overlying the uterine scar are both strongly associated with PAS. The false-positive rate of expert imaging was shown to be 7.7%.…”

“…Planned PAS management appears to be based chiefly on local tradition, resources, and the anticipated severity. Postpartum complications demanded emergent interventions in conservatively managed women, therefore ongoing vigilance and the ability to perform emergent hysterectomy remains a critical skill, even in centers where conservative management is routinely carried out 18 …”

Clinical profiles of placenta accreta spectrum: the PACCRETA population‐based study

“…The definition of PAS is essential in ensuring that studies are comparable. A major issue with PAS studies is that histopathology of the placenta only does not necessarily provide a definitive answer and, regarding the uterus, is not always available if no hysterectomy is performed 29 . This is particularly the case regarding the conservative treatment that leaves the placenta in situ for spontaneous resorption, which necessarily makes histopathology impossible 30 .…”

“…A major issue with PAS studies is that histopathology of the placenta only does not necessarily provide a definitive answer and, regarding the uterus, is not always available if no hysterectomy is performed. 29 This is particularly the case regarding the conservative treatment that leaves the placenta in situ for spontaneous resorption, which necessarily makes histopathology impossible. 30 Therefore, a combination of clinical and histopathological criteria remains essential for defining and categorising PAS disorders.…”

Conservative management or cesarean hysterectomy for placenta accreta spectrum? Local resources and organization of care matter

“…1 In France, obstetrician-gynecologists working in those centers have the experience and surgical skills to manage PAS, whereas other specialized surgeons are on-call. 3 This is an organization that is close to the one described by the Houston team. 2 Moreover, 1 strength of our large prospective multicenter study was that our results were collected not only from very specialized centers but also from a larger spectrum of specialized and general centers with the inclusion of women with or without a prenatal diagnosis of PAS.…”