Comparative Outcomes of Planned Cesarean Hysterectomy and Conservative Management in Placenta Accreta Spectrum: A Narrative Review

Abstract

Background: Placenta Accreta Spectrum (PAS) is a life-threatening obstetric condition involving abnormal placental adherence or invasion into the uterine wall. Management options include planned cesarean hysterectomy, considered the definitive treatment, and conservative management, which preserves fertility but carries additional risks. Early diagnosis and multidisciplinary care are crucial in improving outcomes. Aim: This review compares maternal outcomes of planned cesarean hysterectomy versus conservative management in PAS and provides evidence-based recommendations for clinical practice. Materials and Methods: A comprehensive search of PubMed, Google Scholar, and ScienceDirect identified 32 studies evaluating outcomes of planned cesarean hysterectomy and conservative management, including maternal morbidity, mortality, blood loss, and neonatal health. Data were analyzed and synthesized to address the study objectives. Results: Planned cesarean hysterectomy was associated with reduced risks of postpartum hemorrhage and readmissions but carried risks of significant intraoperative blood loss (mean >4,000 mL) and surgical complications, such as bladder injury. Conservative management techniques, including the Triple-P procedure and Modified One-Step Conservative Surgery, achieved uterine preservation in up to 88% of cases but had higher rates of delayed complications, such as infection and hemorrhage. Early antenatal diagnosis and multidisciplinary care improved outcomes for both approaches. Conclusions: Planned cesarean hysterectomy remains the gold standard for severe PAS, minimizing maternal morbidity and mortality, while conservative management is a viable option in select cases but requires rigorous follow-up.