Telemedicine-assisted conservative management of placenta accreta spectrum: a case series from a tertiary center in Lithuania.

BACKGROUND

Placenta accreta spectrum (PAS) is a severe obstetric disorder that requires extensive resources and multidisciplinary expertise. In many European centers, low case numbers and the absence of structured training programs limit opportunities to adopt conservative surgical techniques. At present, there is no consensus on the optimal management of PAS. CASE PRESENTATION: We describe the first experience with uterine-sparing surgery for PAS in a Lithuanian tertiary center, developed through collaboration with Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili (Cali, Colombia). Between April and September 2024, four women with antenatally suspected PAS (two increta, two accreta) were treated with one-step conservative surgery (OSCS). Teleconsultation supported each stage of care, including ultrasound review, joint surgical planning, intraoperative assistance, and postoperative debriefing. All four patients recovered without major complications, and neonatal outcomes were favourable. For comparison, outcomes from nine women managed with cesarean hysterectomy between 2022 and 2023 were reviewed.

CONCLUSION

This case series demonstrates that uterine-sparing surgery can be safely introduced in a low-volume setting with structured teleconsultation support. International collaboration provides a practical framework for surgical training and may facilitate broader adoption of conservative PAS management.