Nonconservative vs. Conservative Management of Antenatally Diagnosed Placenta Accreta Spectrum Disorders: A Literature Review of Approaches and Outcomes.

Placenta accreta spectrum (PAS) disorders involve abnormal placental invasion into the uterine wall and neighbouring organs, posing life-threatening risks during and after labour. Catastrophic obstetric haemorrhage remains the main morbidity factor, potentially leading to severe complications, including coagulopathy, acute respiratory distress, cardiac arrest, and, in some cases, death. The traditional, nonconservative approach, caesarean hysterectomy, is widely adopted for managing PAS, but it permanently eliminates fertility and carries a high risk of complications. In response, conservative management methods, such as the expectant approach, one-step conservative surgery and the Triple P procedure, have been developed to address the desire for fertility preservation and reduce surgical complications. Due to limited data in the field, current guidelines do not offer definitive recommendations for the most appropriate management approach in specific clinical situations. Therefore, the management of PAS disorders requires an individualised approach based on various factors, such as the extent of placental invasion, topography, ability to achieve haemostatic control, the patient's desire for future fertility, and the available medical resources and surgical expertise. The current literature review explores the efficacy and safety of both nonconservative and conservative management strategies, highlighting their impacts on maternal and neonatal outcomes, surgical morbidity and future fertility potential.