Wiku Andonotopo, Muhammad Adrianes Bachnas, Manggala Pasca Wardhana, Cut Meurah Yeni, Dudy Aldiansyah, Johny Marpaung, Dovy Djanas, Donel Suhaimi, Nuswil Bernolian, Akhmad Yogi Pramatirta, Adhi Pribadi, Irwan Taufiqurrahman, Eric Edwin Yuliantara, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Bambang Rahardjo, Bambang Abimanyu, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, I Wayan Artana Putra, Agus Rusdhy Hamid, Efendi Lukas, John Wantania, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak
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).
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Women Health Center, Eka Hospital BSD, Banten, Tangerang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Sebelas Maret, Dr Moewardi General Hospital, Solo, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Airlangga, Dr Soetomo General Hospital, Surabaya, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Syiah Kuala, Dr Zainoel Abidin General Hospital, Aceh, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Medan, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Andalas, Dr M. Djamil General Hospital, Padang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital, Pekanbaru, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Sriwijaya, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Gadjah Mada, Prof Dr Sardjito General Hospital, Yogyakarta, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Diponegoro, Dr Kariadi General Hospital, Semarang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Brawijaya, Dr Saiful Anwar General Hospital, Malang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital, Banjarmasin, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Udayana, Prof Dr I.G.N.G Ngoerah General Hospital, Bali, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Mataram, Provinsi NTB General Hospital, Mataram, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Universitas Hasanuddin, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Sam Ratulangi University, Prof Dr R.D. Kandou General Hospital, Manado, Indonesia; Department of Neonatology and Rare Diseases, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
