Conservative Management

Assoc. Prof. Dr. Burak Bayraktar1
Prof. Dr. Şevki Çelen2

1Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye

ABSTRACT

Placenta accreta spectrum (PAS) disorders, encompassing placenta accreta, increta, and percreta, represent a significant challenge in obstetrics due to their association with severe maternal morbidity and mortality. These conditions involve abnormal adherence of the placenta to the myometrium, often leading to life-threatening hemorrhage during delivery. While cesarean hysterectomy has been the traditional treatment, it poses con- siderable risks, such as massive blood loss, infection, and organ injury. In contrast, conservative management aims to preserve fertility while reducing surgical morbidity. Candidates for conservative management include patients desiring future fertility, those at high risk for hysterectomy complications, and cases with focal accre- ta or favorable placental location. Key strategies include preoperative imaging for detailed planning, intraop- erative techniques like leaving the placenta in situ, one-step conservative surgery, and the Triple-P procedure. Postoperative care involves close monitoring for complications like hemorrhage and infection. Although con- servative management carries risks such as recurrence in future pregnancies, it remains a valuable option for selected patients when performed by an experienced multidisciplinary team.

Keywords: Placenta accreta spectrum; Conservative management; Uterine preservation; Fertility preservation; Leaving placenta in situ; One-step conservative surgery; Triple-P procedure; Maternal morbidity

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