This commentary discusses the issues related to conservative management (also called
leaving the placenta in situ or intentional retention of the placenta) of placenta
accreta spectrum disorders. Considerations related to placenta accreta spectrum disorder
management in the United States are compared with France, where conservative management
is a well-accepted management option. The history of placenta accreta spectrum disorder
treatment is reviewed, finding that since 1937, the most common treatment in the United
States been cesarean-hysterectomy without placental removal. Although definitive studies
have yet to be conducted, a growing body of evidence suggests that conservative management
is able to reduce maternal morbidity, compared with cesarean-hysterectomy. International
and national guidelines from several countries are examined. Comparisons between the
United States and France that are addressed in the commentary include population and
geography, structure of the healthcare system, physician training and acceptability,
and patient acceptability. Considering the differences between the countries, conservative
management is feasible in the United States. Different options for placenta accreta
spectrum disorder management should be rigorously researched in multicenter international
collaborations. Conservative management should be considered as an option for women
with placenta accreta spectrum disorders in the United States, especially for those
desiring fertility preservation.
Key words
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Article info
Publication history
Published online: September 12, 2022
Accepted:
August 31,
2022
Received:
August 25,
2022
Footnotes
The authors report no conflict of interest.
No financial support was received for this study.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
