Segmental Resection in Placenta Accreta Spectrum: Current Evidence and Evolving Role in Uterine Preservation

Abstract

Background: Placenta accreta spectrum disorders are characterized by abnormal placental adherence and invasion into the myometrium and adjacent structures. Cesarean hysterectomy is effective in controlling hemorrhage but carries substantial morbidity and definitively terminates reproductive potential. Uterine-sparing approaches have therefore been developed for carefully selected patients.

Aim: To review uterine-sparing management of placenta accreta spectrum, with particular emphasis on antenatal diagnosis, patient selection, surgical principles, intraoperative considerations, and the effectiveness of segmental resection.

Conclusion: Segmental resection represents a uterine-sparing approach that directly addresses abnormal placentation through targeted excision and reconstruction. Appropriate patient selection, accurate preoperative mapping, multidisciplinary support, vascular control, and the capability to proceed immediately to hysterectomy when conservative management is unsuccessful are essential for safe application of this approach.