Organ-sparing approaches in placenta accreta spectrum

DOI

https://dx.doi.org/10.18565/aig.2026.112

Prikhodko A.M., Kan N.E., Tsukanova A.A., Amiraslanov E.Yu., Tyutyunnik V.L.
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Placenta accreta spectrum (PAS) is one of the dangerous complications of pregnancy, posing a serious threat to both mother and fetus. Placental abnormalities detected only during surgery are associated with a high risk of excessive bleeding, surgical complications and hysterectomy. Early detection of the condition enables the patient to be referred to a specialized hospital where the most appropriate course of treatment can be prescribed.
Traditionally, the main surgical procedure is hysterectomy, although organ-sparing surgery is now becoming increasingly common. A systematic review of publications on organ-sparing surgeries for PAS was conducted. These interventions include leaving the placenta in situ, metroplasty, tourniquet hemostasis, the Triple P technique, compression sutures, uterine artery embolization, temporary balloon occlusion of the iliac arteries and the aorta, and resuscitative endovascular balloon occlusion of the aorta (REBOA). The following databases were used for the electronic search: PubMed, eLibrary and MEDLINE. The search identified 285 potentially relevant sources, of which 50 papers on methods of organ-sparing childbirth were included in the review.
Organ-sparing approaches in PAS have been shown to reduce intraoperative blood loss and the need for blood transfusions in a number of cases. Additionally, they can lower the incidence of hysterectomies and preserve reproductive potential. However, their effectiveness depends directly on the coordinated work of a multidisciplinary team, the surgeon’s high level of expertise and the technical equipment available in the operating theatre.
Conclusion. Organ-sparing surgeries play an important role in the management of patients with PAS. The choice of treatment approach should be based on the extent of the intervention, the patient’s clinical condition and the resources available at the facility. Modern techniques, such as REBOA, can significantly improve treatment and neonatal outcomes and minimize the risk of excessive bleeding. Future research is needed to standardize approaches and compare the effectiveness of different organ-sparing strategies.

Authors’ contributions. Prikhodko A.M., Kan N.E., Tsukanova A.A., Amiraslanov E.Yu., Tyutyunnik V.L. – developing the concept and design of the study, collecting the data for analysis, compiling publications, processing and analysis of material on the topic, writing the manuscript, editing the text.
Conflicts of interest. The authors declare that there are no conflicts of interest.
Funding. The study was conducted without sponsorship.
Ethical Approval. The study was approved by the Ethical Review Board of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia (Protocol No. 2 of 19 February 2026).
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this article.
For citation: Prikhodko A.M., Kan N.E., Tsukanova A.A., Amiraslanov E.Yu.,
Tyutyunnik V.L. Organ-sparing approaches in placenta accreta spectrum.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (7): 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2026.112

placenta accreta spectrum

abnormal placental invasion

organ-sparing surgery

uterine artery embolization

endovascular balloon occlusion of the aorta

Full text (in Russian)

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Received 02.04.2026

Accepted 18.05.2026

Andrey M. Prikhodko, Dr. Med. Sci., Deputy Director for Research at the Institute of Obstetrics, Head of the Department of Innovative Development, Associate Professor of the Department of Obstetrics and Gynecology, Associate Member of the Russian Academy of Sciences, obstetrician-gynecologist at the 1st Maternity Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparin str., 4, +7(965)344-21-11, andrpri@mail.ru, https://orcid.org/0000-0002-6615-2360
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director for Research - Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, kan-med@mail.ru, Researcher ID: B-2370-2015,
SPIN-code: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Angelina A. Tsukanova, clinical resident, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, an-c-00@mail.ru, https://orcid.org/0009-0007-6827-8470
Elrad Yu. Amiraslanov, PhD, Head of the Department of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, eldis@mail.ru, https://orcid.org/0000-0001-5601-1241
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at the Research and Development Service, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, tioutiounnik@mail.ru, Researcher ID:B-2364-2015,
SPIN-code: 1963-1359, Authors ID: 213217. Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Corresponding author: Andrey M. Prikhodko, andrpri@mail.ru

Organ-sparing approaches in placenta accreta spectrum

Prikhodko A.M., Kan N.E., Tsukanova A.A., Amiraslanov E.Yu., Tyutyunnik V.L.

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