{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:21:05Z","timestamp":1791645665517,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":32,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>Data from women in 15 referral centers of the International Society of PAS (IS\u2010PAS) were analyzed and correlated with the clinical classification of the IS\u2010PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600\u00a0mL (range 150\u201020 000\u00a0mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). The mode of delivery in the majority of women (n\u00a0=\u00a0252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.002) in 2018\u20102019 compared with 2009\u20102017, suggesting a positive learning curve.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.14096","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T04:48:19Z","timestamp":1611377299000},"page":"12-20","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-7412","authenticated-orcid":false,"given":"Heleen J.","family":"van Beekhuizen","sequence":"first","affiliation":[{"name":"Department of Gynecological Oncology Erasmus MC Cancer Institute  Rotterdam the 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0759-832X","authenticated-orcid":false,"given":"Wolfgang","family":"Henrich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Department of Experimental Obstetrics Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Corporate Member of Freie Universit\u00e4t Berlin Humboldt\u2010Universit\u00e4t zu Berlin Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8405-772X","authenticated-orcid":false,"given":"Karin A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3528-2389","authenticated-orcid":false,"given":"Mina","family":"MHallem Gziri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Cliniques Universitaires Saint\u2010Luc  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0009-3625","authenticated-orcid":false,"given":"Lo\u00efc","family":"Sentilhes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Bordeaux University Hospital  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-3711","authenticated-orcid":false,"given":"Lene","family":"Gronbeck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9639-7038","authenticated-orcid":false,"given":"Frederic","family":"Chantraine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Li\u00e8ge, Site CHR Citadelle  Li\u00e8ge Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6359-1328","authenticated-orcid":false,"given":"Oliver","family":"Morel","sequence":"additional","affiliation":[{"name":"Nancy Regional and University Hospital Center (CHRU Women\u2019s Division Universit\u00e9 de Lorraine  Nancy France"},{"name":"Diagnosis and International Adaptive Imaging (IADI) Unit Inserm Universit\u00e9 de Lorraine  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9297-5363","authenticated-orcid":false,"given":"Charline","family":"Bertholdt","sequence":"additional","affiliation":[{"name":"Nancy Regional and University Hospital Center (CHRU Women\u2019s Division Universit\u00e9 de Lorraine  Nancy France"},{"name":"Diagnosis and International Adaptive Imaging (IADI) Unit Inserm Universit\u00e9 de 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3191-9362","authenticated-orcid":false,"given":"Johannes J.","family":"Duvekot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Obstetrics and Prenatal Medicine Erasmus MC University Medical center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the International Society of Placenta Accreta Spectrum (IS\u2010PAS) 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