Conservative Management of Placenta Accreta Spectrum Is Associated With Improved Surgical Outcomes Compared With Cesarean Hysterectomy: A Systematic Review and Meta-Analysis

( Am J Obstet Gynecol . 2025 May;232(5):432-452.e3. doi: 10.1016/j.ajog.2025.01.030.) Damage to the endometrial-myometrial interface of the uterus can result in a disorder called placenta accreta spectrum (PAS) disorder, and PAS has been associated with increased morbidity and mortality, including hemorrhage, sepsis, and other complications. Factors that elevate the risk of PAS include previous cesarean delivery (CD), placenta previa, and maternal age >35. Both average maternal age and CD rates have been rising in recent years, and the incidence of PAS has reflected a similar trend. The standard management for PAS is cesarean hysterectomy (CH), and patients with PAS account for an estimated 38% of peripartum hysterectomies. Recent research has highlighted a more conservative approach for patients who desire fertility preservation, involving leaving the placenta in situ with close monitoring. Other conservative techniques involve partial resection of the adherent placenta and myometrium and then repair of the damaged myometrium. Studies have shown some improved outcomes comparing these conservative management (CM) approaches to CH. Though single-center studies and case reports demonstrate preliminary evidence supporting CM of PAS, there are few larger studies evaluating related outcomes. This study was a systematic review and meta-analysis designed to assess maternal outcomes following CM versus CH for patients with PAS.