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intentional retention of the placenta

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Chapter 17 - Management of Placenta Accreta Spectrum
- By Ammar Al Naimi, Sally Collins
Edited by Sir Sabaratnam Arulkumaran, St George's Hospital Medical School, University of London
Book:

Best Practice in Labour and Delivery

Published online:

16 October 2025

Print publication:

06 November 2025, pp 202-214
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Summary

Placenta accreta spectrum (PAS) is a disorder that describes the pathological attachment of the placenta to the myometrium. The continuously rising PAS rates combined with its significant association with a history of caesarean delivery increase the likelihood of encountering women with PAS in obstetric practice. This multifactorial disorder could be associated with serious maternal and fetal morbidity and mortality. Therefore, it is critical to recognise women at risk and provide tailored antenatal care. This chapter discusses the aetiology, impact and known risk factors for PAS. It lists the available diagnostic tools, based on antenatal sonographic and magnetic resonance imaging, and provides recommendations for optimal management of women suspected to have PAS. It summarises the surgical options such as the classical peripartum hysterectomy and compares it to other conservative options using the best available evidence. This chapter provides a comprehensive literature review followed by key learning points for appropriate management.