Rethinking Placenta Accreta Spectrum: A Topography-Based Framework for Prenatal Imaging and Individualized Surgery

The authors aim to address the challenges of predicting surgical complexity and selecting appropriate operative strategies for placenta accreta spectrum (PAS) by proposing a topography-based framework that integrates prenatal imaging, lesion anatomy, and vascular remodeling. They argue that understanding PAS as a disorder of uterine scar remodeling, rather than solely focusing on the depth of placental invasion, can improve surgical planning and facilitate individualized treatment options, including uterine-preserving surgeries. This synthesis of current evidence seeks to enhance clinical decision-making and highlight areas for future research in managing PAS.