Conservative Management of Placenta Accreta Spectrum: The Role of Cervical Length as a Predictive Tool

Abstract

Background: Placenta accreta spectrum (PAS) disorders represent a critical obstetric challenge characterized by abnormal placental invasion into the uterine wall, with rising incidence attributed to increasing cesarean delivery rates. While cesarean hysterectomy remains the conventional management approach, growing interest in fertility-preserving conservative surgical techniques has emerged. However, predicting surgical success and identifying high-risk candidates for conservative management remains challenging. Recent evidence suggests that cervical length (CL), measured by transvaginal ultrasound, may serve as a valuable anatomical predictor of surgical complexity and hemorrhagic complications in PAS cases. Shorter cervical length has been associated with more extensive lower uterine segment involvement, increased intraoperative bleeding, prolonged operative duration, and higher rates of conversion to hysterectomy. Understanding the relationship between CL and surgical outcomes could enhance preoperative risk stratification, facilitate multidisciplinary preparation, and support individualized patient counseling regarding uterine preservation options.