Objective To evaluate the impact of modified cesarean section techniques on pregnancy outcomes in cases involving placenta accreta spectrum （PAS）. Methods A retrospective study was conducted to enroll 176 pregnant women with PAS who underwent cesarean delivery at the First Hospital of Shanxi Medical University between January 2016 and January 2025. Patients who received traditional cesarean delivery before January 17, 2021， were assigned to the control group （n = 115）， while those who underwent a modified cesarean procedure after that date were included in the modified group （n = 61）. Clinical data， including gestational age， maternal age， gravidity， and intraoperative blood loss， were collected and compared between the two groups. Subsequently， a random forest algorithm was employed to develop a risk prediction model for adverse pregnancy outcomes in patients with PAS. Results In the modified group， only one patient required a hysterectomy （1.64%）， which was significantly lower than the 19 cases observed in the control group （16.52%）. The modified group also demonstrated a higher intraoperative diagnosis rate of placenta accreta， along with lower incidences of hemorrhagic shock， disseminated intravascular coagulation， and neonatal asphyxia compared to the control group. However， the proportions of patients undergoing uterine compression sutures and uterine artery ligation were higher in the modified group， with statistically significant differences （P < 0.05）. Patients were further classified into low?bleeding and high?bleeding subgroups for subgroup analysis. A significant difference in gravidity was observed between the two subgroups （P < 0.05）， whereas no significant difference was found in the proportion of patients receiving the modified procedure （P > 0.05）. A predictive model for refractory postpartum hemorrhage was developed with high discriminative ability （AUC = 0.938， 95%CI： 0.917 ~ 0.958）. Gini coefficient analysis identified gravidity， number of abortions， and ultrasound diagnosis of placenta accreta as key predictors of refractory postpartum hemorrhage （P < 0.05）. Conclusion Improved cesarean section techniques can effectively reduce intraoperative and postoperative bleeding in cases of PAS， significantly lowering the risk of hysterectomy and thereby improving pregnancy outcomes.