Placenta Accreta Spectrum and Cesarean Trends: Global Insights with Focus on Indonesia

Background: The global rise in cesarean deliveries has raised concerns about maternal health, particularly the increasing prevalence of placenta accreta spectrum (PAS). While cesareans are crucial for life-threatening complications, their overuse especially in urban and private healthcare settings has introduced significant health risks. Indonesia exemplifies these challenges, with stark disparities in cesarean rates between urban and rural areas, driven by cultural norms, systemic inequities, and economic incentives. Objectives: This review aims to synthesize global and regional evidence on the link between cesarean trends and PAS, with a focus on Indonesia. It explores systemic drivers, clinical implications, and potential policy and practice interventions to mitigate maternal health risks. Methods: The review integrates findings from global research and Indonesian case studies, analyzing trends, risk factors, and interventions related to cesarean overuse and PAS. The discussion emphasizes both evidence-based clinical practices and innovative approaches such as artificial intelligence (AI)-driven diagnostics. Key findings: Repeated cesarean deliveries significantly increase PAS risk, particularly in resource-limited settings with inadequate diagnostic and surgical expertise. Strategies to reduce cesarean overuse such as promoting vaginal births, addressing inequities, and improving obstetric training show promise. Advances in PAS management, including multidisciplinary care and AI applications, demonstrate the potential to improve outcomes but remain inaccessible to many due to systemic healthcare gaps. Conclusion: Addressing the global cesarean epidemic and PAS burden requires a multifaceted approach. Policymakers and healthcare providers must balance reducing unnecessary cesareans with improving access to lifesaving surgical care. Focused efforts in Indonesia should target systemic disparities, promote evidence-based practices, and invest in advanced technologies to enhance maternal health equity and outcomes. Global collaboration is essential to foster sustainable progress in maternal healthcare. © The Author(s).