Conservative Management for Placenta Accreta

(U-PRESERVE Trial)

Overseen By Beth Pineles, MD Phd

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: University of Pennsylvania

Disqualifiers: Low antenatal suspicion for PAS

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: Standard postpartum inpatient stay

15 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method for managing placenta accreta spectrum disorders (PAS), which can cause serious health issues for pregnant individuals. Typically, doctors might remove the uterus to manage PAS, but this trial tests a method called Conservative/Expectant Management, which leaves the placenta in place after birth. This approach uses antibiotics and a procedure called uterine artery embolization to manage the condition while preserving the uterus. The trial targets pregnant individuals who have had a cesarean delivery and placenta previa or a low-lying placenta, and who wish to avoid a hysterectomy. Participants will receive close monitoring during and after delivery. As an unphased trial, this study offers participants the chance to contribute to innovative research that could transform PAS management and preserve reproductive health.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What prior data suggests that this conservative management technique is safe for placenta accreta spectrum disorders?

Research has shown that managing placenta accreta without surgery can be safer than the usual method of removing the uterus during a C-section. This approach often results in less blood loss and fewer injuries to nearby areas like the bladder, and it reduces the need for intensive care after birth.

One review found that women who chose this non-surgical method experienced better outcomes, with fewer complications and a good recovery after delivery. Another study found that babies were born healthy, often after 34 weeks of pregnancy, when this method was used.

While all medical treatments carry risks, evidence suggests that with careful monitoring and support, this approach can be well-tolerated. It is important for each person to discuss with their healthcare provider to determine if this option is suitable for them. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the conservative management approach for placenta accreta because it offers a potential alternative to the standard treatment, which often involves a hysterectomy. This method focuses on preserving the uterus by using antibiotics and uterine artery embolization, combined with close monitoring. The key advantage here is the possibility of maintaining fertility, which is a significant concern for many patients. This approach is particularly appealing as it aims to manage the condition without resorting to more invasive surgical procedures.

What evidence suggests that conservative management is effective for placenta accreta?

Studies have shown that managing placenta accreta spectrum (PAS) without immediate surgery can lead to better outcomes than the usual method of removing the uterus during a C-section. In this trial, participants will undergo conservative management, which involves leaving the placenta in the uterus after the baby is born, using antibiotics and uterine artery embolization, and close monitoring. This approach can greatly reduce blood loss, damage to nearby organs, and the need for intensive care. Research indicates that this method works well in about 78% to 80% of cases. Women who choose this option often experience fewer complications compared to those who have the placenta surgically removed. This method also allows some women to keep their uterus, which is important for those who want to have more children. ^{1 2 3 4 5}

Who Is on the Research Team?

Beth Pineles, MD PhD

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for individuals with a uterus, aged 18 or older, who are currently 16-36 weeks pregnant and have been diagnosed with placenta accreta spectrum disorders. They must want to keep their uterus, have had a cesarean before, and usually would be offered a cesarean-hysterectomy. Participants need to consent to the study's requirements and lifestyle considerations.

Inclusion Criteria

Provision of signed and dated informed consent form

Agreement to adhere to Lifestyle Considerations throughout study duration

I want to keep my uterus.

Exclusion Criteria

Have a low antenatal suspicion for PAS based on imaging

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Conservative management of PAS with antibiotics and uterine artery embolization, followed by close monitoring

Standard postpartum inpatient stay

Inpatient stay

Follow-up

Participants are monitored for safety and effectiveness after treatment until the uterus is empty

Up to 1 year

Outpatient follow-up

What Are the Treatments Tested in This Trial?

Interventions

• Conservative/Expectant Management

Trial Overview

The study tests conservative management of placenta accreta spectrum disorders by leaving the placenta in place after delivering the baby. This approach aims to preserve the uterus and avoid immediate surgery post-delivery. All participants will receive this intervention in a single-arm pilot study at one site.

How Is the Trial Designed?

Group I: Uterine preservation Experimental Treatment 1 Intervention

Conservative management of PAS with the inclusion of antibiotics and uterine artery embolization, followed by close monitoring.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Citations

1.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/39884567/

Conservative management of placenta accreta spectrum is ...

Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: a ...

2.

ajog.org

ajog.org/article/S0002-9378(25)00063-8/fulltext

Conservative management of placenta accreta spectrum is ...

This meta-analysis supports that conservative management of PAS is associated with significant reduction in blood loss, GU injury, and ICU admission (for ...

3.

obgyn.onlinelibrary.wiley.com

obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.70008

Placenta accreta spectrum: management update - Walker - 2025

Maternal outcomes of conservative management and cesarean hysterectomy for placenta accreta spectrum disorders: a systematic review and meta- ...

4.

bmcpregnancychildbirth.biomedcentral.com

bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06658-x

Maternal outcomes of conservative management and ...

This systematic review aims to compare maternal outcomes according to conservative management or cesarean hysterectomy in women with placenta accreta spectrum ...

5.

journals.lww.com

journals.lww.com/mfm/fulltext/2021/10000/placenta_accreta_spectrum__conservative_management.7.aspx

Placenta Accreta Spectrum: Conservative Management ...

Expectant management is effective in up to 78%–80% of the cases. The extirpative method is associated with a high risk of postpartum hemorrhage. The success of ...