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Volume 13
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10.3390/jdb13040045
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Pathophysiology and Management of Placenta Accreta Spectrum

by
Lana Shteynman
1,
Genevieve Monanian
2,
Gilberto Torres
1,
Giancarlo Sabetta
1,
Deborah M. Li
1,
Zhaosheng Jin
2,*,
Tiffany Angelo
2,
Bahaa E. Daoud
2 and
Morgane Factor
2
1
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
2
Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA
*
Author to whom correspondence should be addressed.
J. Dev. Biol. 2025, 13(4), 45; https://doi.org/10.3390/jdb13040045
Submission received: 1 October 2025 / Revised: 17 November 2025 / Accepted: 5 December 2025 / Published: 10 December 2025
Versions Notes

Abstract

Placenta Accreta Spectrum (PAS) disorders, including placenta accreta, increta, and percreta, are serious obstetric conditions characterized by abnormal placental adherence to the uterine wall. With increasing incidence, PAS poses significant risks, primarily through massive hemorrhage during or after delivery, often necessitating hysterectomy. Key risk factors include prior cesarean sections, uterine surgery, and placenta previa diagnosis. In this review, we will examine the pathophysiology of PAS, with a focus on the mechanisms underlying abnormal trophoblast invasion and defective decidualization. We will highlight the role of uterine scarring, extracellular matrix remodeling, dysregulated signaling pathways, and immune and vascular alterations in disrupting the maternal-fetal interface, ultimately predisposing to morbid placentation and delivery complications. We will also discuss the life-threatening complications of PAS, such as shock and multi-organ failure, which require urgent multidisciplinary intensive care, as well as the optimization of management through preoperative planning and intraoperative blood loss control to reduce maternal morbidity and mortality.
Keywords: placenta accreta spectrum; postpartum hemorrhage; maternal morbidity; decidualization; extravillous trophoblasts; extracellular matrix remodeling; epithelial-to-mesenchymal transition (EMT); preoperative planning placenta accreta spectrum; postpartum hemorrhage; maternal morbidity; decidualization; extravillous trophoblasts; extracellular matrix remodeling; epithelial-to-mesenchymal transition (EMT); preoperative planning

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MDPI and ACS Style

Shteynman, L.; Monanian, G.; Torres, G.; Sabetta, G.; Li, D.M.; Jin, Z.; Angelo, T.; Daoud, B.E.; Factor, M. Pathophysiology and Management of Placenta Accreta Spectrum. J. Dev. Biol. 2025, 13, 45. https://doi.org/10.3390/jdb13040045

AMA Style

Shteynman L, Monanian G, Torres G, Sabetta G, Li DM, Jin Z, Angelo T, Daoud BE, Factor M. Pathophysiology and Management of Placenta Accreta Spectrum. Journal of Developmental Biology. 2025; 13(4):45. https://doi.org/10.3390/jdb13040045

Chicago/Turabian Style

Shteynman, Lana, Genevieve Monanian, Gilberto Torres, Giancarlo Sabetta, Deborah M. Li, Zhaosheng Jin, Tiffany Angelo, Bahaa E. Daoud, and Morgane Factor. 2025. "Pathophysiology and Management of Placenta Accreta Spectrum" Journal of Developmental Biology 13, no. 4: 45. https://doi.org/10.3390/jdb13040045

APA Style

Shteynman, L., Monanian, G., Torres, G., Sabetta, G., Li, D. M., Jin, Z., Angelo, T., Daoud, B. E., & Factor, M. (2025). Pathophysiology and Management of Placenta Accreta Spectrum. Journal of Developmental Biology, 13(4), 45. https://doi.org/10.3390/jdb13040045

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