{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:47:05Z","timestamp":1792644425422,"version":"4.5.0"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal placental adherence to the uterus that can lead to major maternal morbidity. While hysterectomy has traditionally been the standard management, uterus-preserving approaches are increasingly used to preserve fertility. The risk of recurrent PAS in subsequent pregnancies and the overall fertility outcomes following conservative management remain unclear. Objective: We aimed to estimate the recurrence risk of PAS in subsequent pregnancies after conservative management and to assess fertility outcomes, including pregnancy and live-birth rates. Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search was performed across multiple databases to identify studies reporting subsequent pregnancies after conservative PAS management. Data extraction and quality assessment were independently conducted. Pooled recurrence and pregnancy success rates were calculated using random-effects meta-analysis. Results: Eleven studies met the inclusion criteria, involving 2642 patients who underwent conservative PAS management. The pooled recurrence risk of PAS in subsequent pregnancies was 20.9% (95% CI: 12.2\u201329.6). Successful pregnancy rates following conservative treatment were 69.7% (95% CI: 49.9\u201389.5). Conclusions: While conservative PAS management poses a risk of recurrence, it remains a viable fertility-preserving option, with high subsequent pregnancy success rates. These findings support informed clinical decision-making, though further prospective studies are needed to optimize management strategies and patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm15051684","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:54:56Z","timestamp":1771923296000},"page":"1684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Subsequent Pregnancies After Conservative Placenta Accreta Management: Recurrent Accreta and Preserved Fertility, a Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-935X","authenticated-orcid":false,"given":"Shmuel","family":"Somer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6527-7866","authenticated-orcid":false,"given":"Doron","family":"Kabiri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1806-0418","authenticated-orcid":false,"given":"Lauren H.","family":"Yaeger","sequence":"additional","affiliation":[{"name":"Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shmuel","family":"Herzberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2290-4150","authenticated-orcid":false,"given":"Yossef","family":"Ezra","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9940-4280","authenticated-orcid":false,"given":"Aharon","family":"Tevet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5843-9399","authenticated-orcid":false,"given":"Joshua I.","family":"Rosenbloom","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2147\/IJWH.S224191","article-title":"Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies","volume":"12","author":"Morlando","year":"2020","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine (2018). Obstetric care consensus no. 7: Placenta accreta spectrum. Obstet. Gynecol., 132, e259\u2013e275.","DOI":"10.1097\/AOG.0000000000002983"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"239","DOI":"10.5468\/ogs.20345","article-title":"Placenta accreta spectrum-a catastrophic situation in obstetrics","volume":"64","author":"Pegu","year":"2021","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Herzberg, S., Ezra, Y., Yahya, R.H., Weiniger, C.F., Hochler, H., and Kabiri, D. (2022). Long-term gynecological complications after conservative treatment of placenta accreta spectrum. Front. Med., 9.","DOI":"10.3389\/fmed.2022.992215"},{"key":"ref_5","first-page":"277","article-title":"A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup","volume":"30","author":"Berhan","year":"2020","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ijgo.2009.12.011","article-title":"Fertility and obstetric outcome after conservative man-agement of placenta accreta","volume":"109","author":"Provansal","year":"2010","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ejogrb.2021.02.001","article-title":"What we know about placenta accreta spectrum (PAS)","volume":"259","author":"Liu","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jauniaux, E., Collins, S., and Burton, G. (2018). Placenta accreta spectrum: Pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am. J. Obstet. Gynecol.","DOI":"10.1016\/j.ajog.2017.05.067"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ogc.2015.01.014","article-title":"Placenta accreta spectrum: Accreta, increta, and percreta","volume":"42","author":"Silver","year":"2015","journal-title":"Obstet. Gynecol. Clin. North Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1097\/GRF.0000000000000395","article-title":"Conservative Management of Placenta Accreta Spectrum","volume":"61","author":"Sentilhes","year":"2018","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.ajog.2025.01.030","article-title":"Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: A systematic review and meta-analysis","volume":"232","author":"Hessami","year":"2025","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/ijgo.15220","article-title":"Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single-center retrospective analysis based on 619 Vietnamese pregnant women","volume":"165","author":"Vuong","year":"2023","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ajog.2023.10.047","article-title":"Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: A systematic review and meta-analysis","volume":"230","author":"Javinani","year":"2023","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1097\/AOG.0000000000004051","article-title":"Outcomes of Subsequent Births After Placenta Accreta Spectrum","volume":"136","author":"Baldwin","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijgo.2014.05.013","article-title":"Outcomes of subsequent pregnancies after conservative treatment for placenta accreta","volume":"127","author":"Kabiri","year":"2014","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"25870","DOI":"10.1038\/s41598-025-07582-6","article-title":"Evaluating a novel approach to placenta accreta spectrum management: The modified Triple-P technique with cystoinflation (a randomized controlled trial)","volume":"15","author":"Saaqib","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"219.e1","DOI":"10.1016\/j.ajog.2012.12.037","article-title":"Placenta accreta: Risk factors, perinatal outcomes, and consequences for subsequent births","volume":"208","author":"Eshkoli","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/AOG.0000000000001843","article-title":"Pathologically diagnosed placenta accreta and hemorrhagic morbidity in a subsequent pregnancy","volume":"129","author":"Roeca","year":"2017","journal-title":"Obs. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1093\/humrep\/deq239","article-title":"Fertility and pregnancy outcomes following conservative treatment for placenta accreta","volume":"25","author":"Sentilhes","year":"2010","journal-title":"Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S483","DOI":"10.1016\/S0020-7292(12)61061-3","article-title":"Conservative management of placenta previa-accreta by prophylactic uterine arteries ligation and stepwise vertical compression sutures","volume":"119","author":"Sherbiny","year":"2012","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00404-019-05175-z","article-title":"Self-reported physical, mental, and reproductive sequelae after treatment of abnormally invasive placenta: A single-center observational study","volume":"300","author":"Welz","year":"2019","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/AOG.0000000000005926","article-title":"Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder","volume":"145","author":"Amro","year":"2025","journal-title":"Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2477782","DOI":"10.1080\/14767058.2025.2477782","article-title":"Subsequent pregnancy outcomes following conservative management for placenta accreta spectrum disorders: An ambispective cohort study","volume":"38","author":"Chen","year":"2025","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_25","first-page":"068","article-title":"Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study","volume":"42","author":"Ohayon","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ejogrb.2006.07.050","article-title":"Management of placenta accreta: Morbidity and outcome","volume":"133","author":"Bretelle","year":"2007","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","first-page":"549","article-title":"[Conservative treatment of placenta accreta]","volume":"32","author":"Bretelle","year":"2003","journal-title":"J. Gynecol. Obstet. Biol. Reprod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3233\/NPM-15915028","article-title":"The recurrence risk of placenta accreta following uterine conserving management","volume":"8","author":"Cunningham","year":"2016","journal-title":"J. Neonatal-Perinat. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"777","DOI":"10.3109\/01443615.2015.1011106","article-title":"Systematic review of uterus-preserving treatment modalities for abnormally invasive placenta","volume":"35","author":"Mei","year":"2015","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100749","DOI":"10.1016\/j.ajogmf.2022.100749","article-title":"Is conservative management of placenta accreta spectrum disorders practical in the United States?","volume":"5","author":"Pineles","year":"2023","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.0001-6349.2005.00504.x","article-title":"Surgical uterine devascularization for placenta accreta: Immediate and long-term follow-up","volume":"84","author":"Verspyck","year":"2005","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1055\/a-1885-1942","article-title":"Leaving the Placenta In Situ in Placenta Accreta Spectrum Disorders: A Single-Center Case Series","volume":"41","author":"Pineles","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1111\/j.1471-0528.2005.00666.x","article-title":"Parallel vertical compression sutures: A technique to control bleeding from placenta praevia or accreta during caesarean section","volume":"112","author":"Hwu","year":"2005","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1016\/j.jmig.2012.08.193","article-title":"Conservative Treatment by Hysteroscopic Resection of Placenta Accreta","volume":"19","author":"Legendre","year":"2012","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1684\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:42:36Z","timestamp":1771926156000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051684"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051684","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}