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We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Cross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL\u2009+\u2009CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>From a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL\u2009+\u2009CST had a significant reduction in intraoperative blood loss (\u03b2=-312 ml, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001), RBC transfusion (\u03b2=-1.08 unit, <jats:italic>P<\/jats:italic>\u2009=\u2009.001), but required more surgery time (\u03b2\u2009=\u200916.43\u00a0min, <jats:italic>P<\/jats:italic>\u2009=\u2009.01). MRI-measured placenta thickness, when above 50\u00a0mm, can increase blood loss (\u03b2\u2009=\u2009315 ml, <jats:italic>P<\/jats:italic>\u2009=\u2009.01), RBC transfusion (\u03b2\u2009=\u20091.28 unit, <jats:italic>P<\/jats:italic>\u2009=\u2009.01), surgery time (\u03b2\u2009=\u200948.84\u00a0min, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001) and hospital stay (\u03b2\u2009=\u20092.58\u00a0day, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>A conservative surgical management approach of UAL\u2009+\u2009CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical trial registration number<\/jats:title>\n                <jats:p>: ChiCTR2000035202.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-023-05923-9","type":"journal-article","created":{"date-parts":[[2023,8,26]],"date-time":"2023-08-26T06:01:57Z","timestamp":1693029717000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study"],"prefix":"10.1186","volume":"23","author":[{"given":"Wenxia","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinrui","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingfeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiying","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shixia","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqiang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoxi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,8,26]]},"reference":[{"issue":"1","key":"5923_CR1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1002\/ijgo.12761","volume":"146","author":"E Jauniaux","year":"2019","unstructured":"Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S, Diagnosis FPA, et al. 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Eur J Obstet Gynecol Reprod Biol. 2018;225:214\u201320.","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-023-05923-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12884-023-05923-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-023-05923-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T11:19:04Z","timestamp":1700392744000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/s12884-023-05923-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,26]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["5923"],"URL":"https:\/\/doi.org\/10.1186\/s12884-023-05923-9","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,26]]},"assertion":[{"value":"7 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of Linyi Maternal and Child Healthcare Hospital. All methods were carried out in accordance with relevant institutional guidelines and regulations. Informed consent was obtained from patients who are followed up for postoperative outcomes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"615"}}