New study offers promising alternative to high-risk surgery for rare pregnancy complication

Leaving the placenta in place after childbirth may offer a safer alternative to immediate surgery for women with placenta accreta spectrum (PAS), according to a new study led by researchers at UTHealth Houston and published by the American College of Obstetricians and Gynecologists.

PAS is a rare but serious pregnancy complication in which the placenta attaches too deeply to the uterine wall, often causing severe bleeding during childbirth. Traditionally, the condition is treated with a cesarean hysterectomy — removing the uterus immediately after delivery — but this procedure carries significant risks, including heavy blood loss, infection, and damage to surrounding organs.

In the new study, Farah Amro, MD, assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at UTHealth Houston, and medical director of the PAS Program at UTHealth Houston, tested an alternative approach leaving the placenta in place after delivery to either allow it to be absorbed naturally or to perform a delayed hysterectomy when it is safer.

Amro will present the findings this week at the American College of Obstetricians and Gynecologists’ Annual Clinical and Scientific Meeting.

“The traditional treatment for PAS has been cesarean hysterectomy; however, the procedure carries high risks, including severe bleeding, infection, and possible injury to other organs,” Amro said. “In our study – the only one of its kind evaluating uterine preservation for PAS in the United States – we found that when the placenta is left under careful monitoring, patients experienced less blood loss and required fewer transfusions, avoiding hysterectomy altogether.”

Of 180 patients diagnosed with PAS between January 2015 and December 2024, Amro’s team left the placenta in place in 43 patients. Among those women, 29 planned to keep their uterus, and 14 planned for delayed hysterectomies. In 13 cases, leaving the placenta intact was successful, with it naturally breaking down over a median period of about 17 weeks. Five women in the study later had healthy pregnancies without complications related to PAS.

“Given the rarity of PAS, our findings are significant and offer women hope and increased options,” Amro said. “As someone who takes care of these patients, my immediate observation was how grateful they were to have a choice; it helped the women I treat feel more empowered about their reproductive health care decisions.”

Amro also emphasized that further research is essential to identify which patients are the most suitable candidates for the approach and that larger, multicenter studies along with standardized protocols are necessary to fully understand the benefits, risks, and potential complications of leaving the placenta in place.

“Our study is just the beginning and a launching point for continued exploration into safer, more individualized treatment options for women with PAS so they can make informed decisions and have the best possible outcomes for themselves and their families,” Amro said.

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