Abstract
<jats:p>Placenta accreta spectrum (PAS) is an obstetric emergency characterized by abnormal invasion of the placenta into the myometrium. Its incidence increases in parallel with the rise in cesarean section rates, leading to severe maternal morbidity and mortality. This chapter provides a comprehensive review of the modern management of PAS. Pathophysiology, risk factors, and the importance of antenatal diagnosis (via ultrasonography and magnetic resonance imaging) are detailed. A central pillar of management, the critical role of the multidisciplinary team (MDT) comprising specialists in maternal-fetal medicine, gynecologic oncology, anesthesiology, and urology, is emphasized. Perioperative planning, optimal delivery timing (34–36 weeks), and hemorrhage management strategies are discussed. Standard treatment, planned cesarean hysterectomy, is comparatively examined alongside uterus-preserving surgical techniques such as expectant management or the Triple-P procedure, which aim to preserve fertility. In conclusion, the paradigm shift in the management of PAS management from an unexpected emergency to a meticulously planned intervention by a multidisciplinary team in a specialized center, based on antenatal diagnosis, is identified as the most critical factor in improving maternal outcomes.</jats:p>