Individualized risk-stratified management after HIFU treatment for placenta increta: a fertility preservation strategy

Purpose To evaluate the efficacy, safety, and fertility preservation outcomes of high-intensity focused ultrasound (HIFU) ablation for postpartum placenta increta.Materials and methods This prospective single-center study included 38 patients with postpartum placenta increta treated with ultrasound-guided HIFU from November 2019 to July 2025. Evaluation metrics comprised ablation rate, natural expulsion rate, additional interventions required, β-hCG changes, menstrual recovery, and adverse events.Results Of 38 enrolled patients, 27 were allocated to conservative management and 11 to planned curettage. After excluding 4 patients who elected curettage by personal preference, 34 patients were included in the stratified outcome analysis: 15 (44.1%) achieved spontaneous placental expulsion, while 19 (55.9%) required active intervention (curettage or hysteroscopy). No significant differences in baseline characteristics were observed between the two groups. Serum β-hCG levels and menstrual cycles returned to normal in all patients during follow-up. Among 10 patients who sought subsequent pregnancy, 9 (90%) achieved successful delivery. Treatment-related adverse events were minimal, including treatment-site pain (20.6%) and other minor events (5.9%); no serious complications were recorded. The mean hospital stay was 6.35 days, which was marginally shorter in the spontaneous expulsion group (p = 0.050).Conclusion HIFU is a viable option within a shared decision-making framework for fertility-preserving management of placenta accreta spectrum (PAS) disorder. In conservatively managed cases, HIFU achieved spontaneous placental expulsion in 44.1% of patients; however, 55.9% ultimately required additional intervention, underscoring the need for close coordination with curettage or hysteroscopy. Larger prospective multicenter studies are warranted to establish optimal patient selection criteria and to validate long-term reproductive outcomes.