EC Gynaecology

Placenta accreta spectrum can turn a planned birth into a major haemorrhagic emergency, with consequences that extend well beyond delivery. This critical narrative review examines emerging approaches to diagnosis, treatment and service organisation, drawing on contemporary guidance and selected primary studies. Expert ultrasound remains central to assessment. Artificial intelligence and molecular studies offer new possibilities, but neither has yet established a dependable basis for routine treatment decisions. Evidence for uterus-preserving surgery is growing, although small trials, selected cohorts and limited long-term follow-up leave important questions unanswered. Vascular and urological adjuncts require similarly careful selection. The review also considers sociocultural concerns about hysterectomy, especially in Middle Eastern care, and the ethical limits of attempts to preserve the uterus. We propose a framework that brings diagnostic confidence, surgical complexity, the woman’s priorities and service capability into the same clinical discussion. We also examine Accreta Spectrum Centres, drawing lessons from specialist endometriosis services while recognising the additional demands of obstetric emergencies. Such centres need reliable staffing, transfusion and critical care, together with funded responsibilities to referring hospitals. Their financial value depends on local costs, case volume and the consequences for families. Geography is a denominator of care: performance should be assessed across the whole catchment population, including women who never reach a specialist centre. The priorities are better comparative evidence, accountable referral networks and follow-up that measures physical and psychological recovery. Technical advances will improve care only when women can reach services equipped to use them safely.

Keywords: Placenta Accreta Spectrum; Obstetric Haemorrhage; Precision Surgery; Uterine Preservation; Artificial Intelligence; Maternal Health; Clinical Governance

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