Placenta Accreta Spectrum: A Narrative Review of Clinical Management, Contemporary Innovations, And Global Challenges

Chijioke Ogomegbunam Ezeigwe; George Uchenna  Eleje; Uchenna Paschaline  Eze; Gerald Tochukwu  Igwemadu; Emmanuel Onyebuchi  Ugwu; Emmanuel Chukwubuikem  Egwuatu; Chigozie Geoffrey  Okafor; Chukwuemeka Chukwubuikem  Okoro; Chukwudubem Chinagorom  Onyejiaka; Obinna Kenneth  Nnabuchi; Princeston Chukwuemeka  Okam; Adanna Vivian  Egwim; Charlotte Blanche  Oguejiofor; Malarchy Ekwunife  Nwankwo; Chukwunwendu Aloysius  Okeke; Chigbo Chisom  God’swill; Gerald Okanandu  Udigwe; Joseph Ifeanyichukwu  Ikechebelu; Akaninyene Eseme  Ubom; Kingsley Chidiebere  Nwaogu; Ahizechukwu Chigoziem  Eke

doi:10.55640/ijmsdh-12-07-04

Open Access

Placenta Accreta Spectrum: A Narrative Review of Clinical Management, Contemporary Innovations, And Global Challenges

Vol. 12 No. 07 (2026): Volume 12 Issue 07 | Pages: 26-57 | https://doi.org/10.55640/ijmsdh-12-07-04

Authors

Chijioke Ogomegbunam Ezeigwe
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.
https://orcid.org/0000-0002-6795-3063

George Uchenna Eleje
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. , Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-0390-2152

Uchenna Paschaline Eze
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-0390-2152

Gerald Tochukwu Igwemadu
Department of Obstetrics and Gynaecology, Barking, Havering, and Redbridge, University Hospitals NHS, Romford, London, UK.
https://orcid.org/0000-0002-0390-2152

Emmanuel Onyebuchi Ugwu
Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Nigeria.
https://orcid.org/0000-0002-3342-434X

Emmanuel Chukwubuikem Egwuatu
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-3342-434X

Chigozie Geoffrey Okafor
Department of Obstetrics and Gynaecology, Barking, Havering, and Redbridge, University Hospitals NHS, Romford, London, UK.

Chukwuemeka Chukwubuikem Okoro
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-5772-661X

Chukwudubem Chinagorom Onyejiaka
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-6471-2566

Obinna Kenneth Nnabuchi
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0009-0002-9367-687X

Princeston Chukwuemeka Okam
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-1041-5731

Adanna Vivian Egwim
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-5015-1999

Charlotte Blanche Oguejiofor
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2925-1690

Malarchy Ekwunife Nwankwo
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-1518-7758

Chukwunwendu Aloysius Okeke
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-8305-2978

Chigbo Chisom God’swill
International Research Center of Excellence, Institute of Human Virology, Nigeria.
https://orcid.org/0000-0002-5374-755X

Gerald Okanandu Udigwe
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-5723-3524

Joseph Ifeanyichukwu Ikechebelu
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2515-8464

Akaninyene Eseme Ubom
Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Nigeria

Kingsley Chidiebere Nwaogu
Department of Radiology, Lily Hospitals, Warri, Nigeria.
https://orcid.org/0009-0003-6493-5286

Ahizechukwu Chigoziem Eke
Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Copyright (c) 2026 Chijioke Ogomegbunam Ezeigwe, George Uchenna Eleje, Uchenna Paschaline Eze, Gerald Tochukwu Igwemadu, Emmanuel Onyebuchi Ugwu, Emmanuel Chukwubuikem Egwuatu, Chigozie Geoffrey Okafor, Chukwuemeka Chukwubuikem Okoro, Chukwudubem Chinagorom Onyejiaka, Obinna Kenneth Nnabuchi, Princeston Chukwuemeka Okam, Adanna Vivian Egwim, Charlotte Blanche Oguejiofor, Malarchy Ekwunife Nwankwo, Chukwunwendu Aloysius Okeke, Chigbo Chisom God’swill, Gerald Okanandu Udigwe, Joseph Ifeanyichukwu Ikechebelu, Akaninyene Eseme Ubom, Kingsley Chidiebere Nwaogu, Ahizechukwu Chigoziem Eke

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Authors retain the rights to their work published in the International Journal of Medical Science and Dental Health and may republish or reproduce their own work, provided proper citation to the original publication in IJMSDH is included.

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Ezeigwe, C. O., Eleje, G. U. ., Eze, U. P. ., Igwemadu, G. T. ., Ugwu, E. O. ., Egwuatu, E. C. ., Okafor, C. G. ., Okoro, C. C. ., Onyejiaka, C. C. ., Nnabuchi, O. K. ., Okam, P. C. ., Egwim, A. V. ., Oguejiofor, C. B. ., Nwankwo, M. E. ., Okeke, C. A. ., God’swill, C. C. ., Udigwe, G. O. ., Ikechebelu, J. I. ., Ubom, A. E. ., … Eke, A. C. . (2026). Placenta Accreta Spectrum: A Narrative Review of Clinical Management, Contemporary Innovations, And Global Challenges. International Journal of Medical Science and Dental Health, 12(07), 26-57. https://doi.org/10.55640/ijmsdh-12-07-04

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Abstract

Background: Placenta accreta spectrum (PAS) is a severe obstetric complication characterized by abnormal placental adherence or invasion into the uterine wall, posing significant global reproductive health challenges. While clinical guidelines for PAS exist, a critical knowledge gap remains regarding how to successfully translate high-resource diagnostic innovations and multidisciplinary frameworks into resource-limited settings. Furthermore, there is a lack of synthesized literature evaluating how emerging technologies, such as machine learning models and real-time intraoperative flow assessments, can be integrated with traditional imaging to optimise surgical outcomes.

Objectives: This narrative review comprehensively evaluates the evolving clinical landscape of PAS, examining its epidemiology, pathophysiology, risk factors, and diagnostic advancements, while critically appraising multidisciplinary management frameworks across diverse healthcare resource settings.

Methods: A descriptive narrative approach was utilised to synthesise peer-reviewed publications, consensus guidelines, and clinical studies from PubMed, SCOPUS, Web of Science, and Google Scholar up to June 2026. Data synthesis focused on key parameters including study characteristics, diagnostic modalities (ultrasound, magnetic resonance imaging, and emerging imaging mordalities), and clinical management outcomes, with additional context integrated from regional low- and middle-income country (LMIC) reports.

Results: The incidence of PAS has escalated globally, driven primarily by rising primary and recurrent caesarean section rates. Emerging evidence confirms that the condition arises from an endometrial–myometrial interface defect characterised by thinned or absent decidua basalis, accompanied by molecularly driven hypervascularity and altered tissue adhesion. Modern diagnostic signs, such as intracervical lakes (ICL) and the "rail sign," significantly enhance prenatal identification and predict severe peripartum morbidity. Multidisciplinary care, specialized surgical planning, and intraoperative adjuncts (such as transvaginal ultrasound [TVUS] and machine learning models) improve maternal outcomes, although severe postpartum haemorrhage and maternal mortality remain pronounced in resource-limited systems.

Conclusion: Optimising PAS outcomes requires timely prenatal detection and structured, coordinated care. Advances in ultrasound techniques, combined imaging scores, and real-time intraoperative flow assessments facilitate better risk stratification and surgical optimisation. Addressing current limitations through standardised reporting frameworks

Keywords:

Placenta Accreta Spectrum (PAS), Obstetric Hemorrhage, Prenatal Diagnosis, Multidisciplinary Management, Ultrasound Imaging

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International Journal of Medical Science and Dental Health

eISSN : 2454-4191

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Placenta Accreta Spectrum: A Narrative Review of Clinical Management, Contemporary Innovations, And Global Challenges

Authors

Chijioke Ogomegbunam Ezeigwe

George Uchenna Eleje

Uchenna Paschaline Eze

Gerald Tochukwu Igwemadu

Emmanuel Onyebuchi Ugwu

Emmanuel Chukwubuikem Egwuatu

Chigozie Geoffrey Okafor

Chukwuemeka Chukwubuikem Okoro

Chukwudubem Chinagorom Onyejiaka

Obinna Kenneth Nnabuchi

Princeston Chukwuemeka Okam

Adanna Vivian Egwim

Charlotte Blanche Oguejiofor

Malarchy Ekwunife Nwankwo

Chukwunwendu Aloysius Okeke

Chigbo Chisom God’swill

Gerald Okanandu Udigwe

Joseph Ifeanyichukwu Ikechebelu

Akaninyene Eseme Ubom

Kingsley Chidiebere Nwaogu

Ahizechukwu Chigoziem Eke

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