Key Takeaways
- No official “Centers of Excellence” list exists — use case volume, multidisciplinary team composition, and published outcomes to evaluate hospitals
- ACOG recommends delivery at Level III or higher maternal care facilities with PAS experience
- In Cincinnati, UC Medical Center (Level IV) is the strongest option; for severe cases, consider traveling to a dedicated PAS program
- This ranking prioritizes hospitals with documented fertility preservation capability — the site’s primary audience is patients seeking uterine-sparing options
Why Hospital Choice Matters
If there is one thing the research makes overwhelmingly clear, it is this: where you deliver matters enormously. Outcomes for patients with Placenta Accreta Spectrum are dramatically better at experienced, high-volume centers with dedicated multidisciplinary teams compared to hospitals that encounter PAS only occasionally.
The American College of Obstetricians and Gynecologists (ACOG) recommends that patients with suspected PAS deliver at a Level III or Level IV maternity center — facilities equipped with maternal-fetal medicine specialists, specialized surgical teams, robust blood bank services, adult and neonatal intensive care, and interventional radiology capabilities.
Case volume matters. Studies consistently show that hospitals managing a higher number of PAS cases per year achieve significantly lower rates of hemorrhage, ICU admission, and surgical complications. A center that sees dozens of PAS cases per year will have refined protocols, experienced surgeons, and well-practiced coordination across specialties — advantages that are difficult to replicate at lower-volume institutions.
There is no single official “list” of PAS Centers of Excellence recognized by ACOG, SMFM, or any national accrediting body. The hospitals highlighted below have been identified through published research, clinical reputation, named PAS programs, case volume data, and expert recognition. This guide is meant to help you start your search — not to replace direct evaluation of a center's capabilities for your specific situation.
Top 3 Hospitals in Cincinnati, OH
For patients in the Greater Cincinnati area, these are the most relevant institutions for PAS care, ranked by their level of specialization and evidence of dedicated PAS expertise.
No Cincinnati-area hospital currently offers documented fertility-preserving (uterine-sparing) surgery for PAS. The regional focus is on optimized cesarean hysterectomy and excellent prenatal diagnosis. If preserving your uterus is a priority, you will likely need to travel to a national referral center such as UTHealth Houston, University of Utah, Brigham and Women’s, or Penn Medicine — all of which accept out-of-state referrals and offer telehealth consultations.
University of Cincinnati Medical Center (UC Health)
- First and only Level IV maternity hospital in Greater Cincinnati — the highest designation available
- 8 full-time Maternal-Fetal Medicine (MFM) faculty, 2 advanced practice nurses, and 3 MFM fellows
- Dedicated multidisciplinary prenatal PAS evaluation clinic with coordinated surgical planning
- OB anesthesia team participates directly in preoperative PAS evaluation — a hallmark of best-practice PAS care
- Contact: 513-584-LADY (5239) | MFM referrals: 513-475-8588
Source: uchealth.com
TriHealth Good Samaritan / Cincinnati Children’s Fetal Care Center
- Three-institution collaboration between TriHealth, Cincinnati Children’s Hospital, and the University of Cincinnati
- Evaluated 8,000+ high-risk pregnancies since 2004 through the Fetal Care Center
- Advanced Obstetrical Care Unit with specialized monitoring capabilities
- No dedicated PAS-specific program has been identified in public-facing materials; however, high-risk obstetric expertise is well-established
The Christ Hospital
- Maternal-Fetal Medicine services with experienced MFM specialists
- Level III NICU for neonatal intensive care
- No evidence of a dedicated PAS program has been found in available literature or public-facing information
- For cases of severe PAS (especially percreta), transfer to UC Medical Center is recommended given their Level IV designation and dedicated PAS evaluation clinic
For Cincinnati patients with severe PAS (especially percreta), consider also consulting with dedicated PAS programs at Cleveland Clinic, University of Michigan, or traveling to University of Utah or Baylor/Texas Children’s — all of which have named, high-volume PAS programs with published outcomes data. For fertility-preserving options specifically, also consider UTHealth Houston and Penn Medicine.
Fertility Preservation Centers Map
This interactive map shows the location of PAS hospitals that offer or are developing fertility-preserving care. Green markers indicate confirmed fertility-preservation programs and amber markers indicate emerging capability. Hover over a marker for details; click to visit the hospital profile.
Top 10 Hospitals in the United States
The following institutions are ranked with a focus on fertility preservation capability — the most important factor for patients seeking to preserve their uterus. Rankings weigh published uterine-preservation outcomes, active clinical trials, and documented conservative management programs alongside overall PAS expertise and case volume.
University of Utah Health
- Program Director: Dr. Brett Einerson
- 132 patients in 3 years (institutional data) — among the highest case volumes of any dedicated PAS program in the United States
- National leader in uterine-sparing (fertility-preserving) treatments
- NICHD-funded research on conservative management approaches for PAS
- Named, dedicated program with published outcomes and active clinical trials
UTHealth Houston / UT Physicians
- Medical Director: Dr. Farah Amro, MD
- Published the largest US case series on uterine preservation for PAS — 180 patients (2015–2024), with 29 planned for uterine preservation and 13 (45%) successful17
- Five patients subsequently had healthy pregnancies without PAS recurrence
- Patients with successful preservation had lower blood loss (700 mL vs. 1,950 mL) and fewer transfusions
- One of the first US centers to publish peer-reviewed data on uterine preservation outcomes for PAS
Brigham and Women’s Hospital
- Program lead: Dr. Daniela Carusi
- Abnormal Placentation Program established in 2008 — one of the longest-running dedicated PAS programs in the US
- Hybrid operating room with integrated interventional radiology capability
- Routine use of cell salvage (intraoperative blood recovery) to minimize transfusion needs
Penn Medicine / University of Pennsylvania
- Director: Dr. Beth L. Pineles, MD, PhD
- Running U-PRESERVE trial (NCT06512181) — a pilot study evaluating conservative management (leaving placenta in situ) for patients desiring uterine preservation
- Dr. Pineles trained at UTHealth Houston, gaining direct experience with the leaving-in-situ approach before establishing the Penn program
- Published in AJOG MFM: “Is conservative management of PAS practical in the United States?” — advocating that conservative management should be offered for fertility preservation18
Beth Israel Deaconess Medical Center (BIDMC)
- Director: Dr. Scott Shainker, DO, MSc (Harvard Medical School faculty)
- The New England Center for Placental Disorders (NECPD) is described as an internationally recognized multidisciplinary program and international referral center
- Co-authored systematic review and meta-analysis on subsequent pregnancy outcomes after conservative PAS management (11.8% pooled recurrence rate across 16 studies)38
- Published advocate for conservative management as a fertility-preserving alternative to hysterectomy
Baylor College of Medicine / Texas Children’s Hospital
- Program Leaders: Dr. Michael Belfort & Dr. Alireza Shamshirsaz
- 243 confirmed PAS cases (2011–2018) — one of the highest-volume US centers39
- Published data shows significant outcome improvements with MDT approach: median EBL decreased from 2,000 mL to 1,500 mL, massive transfusion protocol activation from 25.4% to 5.1%21
- 24/7 emergency response capability with Level IV NICU
- Pioneering machine learning PAS prediction research using imaging and clinical data
- Comprehensive multidisciplinary team with dedicated PAS surgical protocol
Columbia University / NewYork-Presbyterian
- Co-directors: Dr. Fady Khoury-Collado, MD (gynecologic oncologist) and Dr. Mirella Mourad, MD (MFM specialist)
- Dr. Khoury-Collado has performed 100+ PAS surgeries and is developing techniques to retain the uterus and remove only the placenta
- Multidisciplinary PAS team since 2018
- No published case series with uterine preservation outcomes yet — techniques are in active development
UTMB Galveston
- Medical Director: Dr. Karin Fox, MD, MEd (Professor of MFM; board member, IS-PAS and PAS²)
- Co-authored “Opportunities for, and barriers to, uterus-preserving surgical techniques for PAS” (Acta Obstet Gynecol Scand, 2024) — a key publication advancing the field
- Dr. Fox is one of the most prolific PAS researchers internationally, previously at Baylor/Texas Children’s
- No UTMB-specific published uterine preservation outcomes yet — program is being established
- Co-directors: Dr. Rebecca Jessel and Dr. Fady Khoury-Collado (also previously listed at Columbia; appears to hold appointments at both institutions)
- Dedicated PAS program formalized ~2024 with structured multidisciplinary planning for each patient
- Unique gynecologic oncology partnership providing advanced surgical expertise for complex cases involving deep tissue invasion
- Program for Advanced Surgical Obstetrics — a named program specifically addressing complex placental disorders
- Dedicated nurse coordinator assigned to each PAS patient for continuity of care and communication throughout the pregnancy
- “Planning-first” approach emphasizing thorough preoperative assessment and individualized surgical strategy before delivery
Fertility Preservation Comparison
For patients who want to preserve their uterus and future fertility, this is one of the most important factors in choosing a hospital. Not all top PAS centers offer fertility-preserving approaches — many focus exclusively on optimizing cesarean hysterectomy outcomes.
If preserving your fertility is a priority, ask specifically whether the hospital offers uterine-sparing surgery and what their published outcomes are. A hospital being “top-ranked” for PAS care does not automatically mean they offer conservative management.
| Hospital | Case Volume | Preservation Rate | Blood Loss Data | Subsequent Pregnancies | Key Complications | Key Evidence |
|---|---|---|---|---|---|---|
| U of Utah | 141 cases (2004–2020) | ~80% avoid hysterectomy | Lower than national average; cell salvage standard | Active NICHD-funded study tracking fertility outcomes | Only center with federally funded long-term follow-up data | NICHD-funded prospective study; only federally funded fertility-preserving PAS research in US |
| UTHealth Houston | 180 patients (2015–2024) | 45% (13/29 planned) | Median 1,500 mL for preservation cases | 5 subsequent healthy pregnancies documented | 55% conversion to hysterectomy when preservation attempted (16/29) | Largest published US single-center case series; Belfort MA pioneer |
| Brigham & Women’s | ~120 PAS cases | Case-by-case | Risk-stratified blood product allocation | 25–35% PAS recurrence rate in subsequent pregnancies (cited by lead physician; no published source) | Individualized approach; outcomes vary by severity | Risk-stratified care model; published multiple PAS management reviews |
| Penn Medicine | Growing (est. 50+) | Active trial | U-PRESERVE trial collecting prospective data | Pending trial results (NCT06512181) | Trial in progress — outcomes not yet published | U-PRESERVE trial (NCT06512181); director trained at UTHealth Houston |
| BIDMC / NECPD | Not published as center-specific volume | Conservative offered | No center-specific data published | No center-specific data published | No center-specific data published | Shainker publications focus on commentaries and pathologic classification (PMID: 35065016) |
| Baylor / Texas Children’s | 243 confirmed (2011–2018) | Hysterectomy-focused | Median 1,500 mL (hysterectomy data; PMID: 29324609) | Not published center-specific | Outcomes improved over time with MDT approach (PMID: 28213059) | Focus on Belfort-Fox hysterotomy technique and hysterectomy optimization |
| Columbia / NYP | 100+ PAS surgeries | Emerging | No published blood loss comparison data | No published fertility outcome data | Developing techniques; no published case series | 100+ total PAS surgeries; developing uterine-sparing protocol |
| UTMB Galveston | Research center | Research focus | Contributing to multi-center data | No published patient-level fertility data | Focus on technique development and classification | Co-authored 2024 uterus-preserving techniques paper; Fox K on IS-PAS board |
| NYU Langone | Newly formalized | Stated goal | No published data | No published data | Program formalized ~2024; building experience | Publicly stated intent to pursue uterine preservation research |
| Cleveland Clinic | Not published | Case-by-case | No published data | No published data | No published protocol or outcomes | Patient materials state “may be able to prevent hysterectomy” |
| Other Notable Centers (hysterectomy-focused — no published fertility preservation data) | ||||||
| Johns Hopkins | High volume | Not offered | CT angiography-guided; optimized hemorrhage control | N/A — hysterectomy standard | Focus on optimized hysterectomy outcomes | CT angiography protocol for surgical planning |
| Duke | Published series | Not offered | P-UAE reduces intraoperative loss | N/A — delayed hysterectomy endpoint | P-UAE + delayed hysterectomy reduces morbidity | Published outcomes data on P-UAE approach |
| Mass General | Research focus | Not offered | No published clinical comparison | N/A | Strong basic science; clinical preservation not documented | Basic science research on placental invasion mechanisms |
| UCSF (MAPS) | 72 total (38 pre-MAPS, 34 post-MAPS) | Not a focus | MAPS protocol: standardized hemorrhage management | N/A — hysterectomy only | MAPS protocol built around cesarean hysterectomy | Published MAPS (Multidisciplinary Approach to Placenta Accreta Spectrum) protocol |
| U of Michigan | Published series | Not a focus | REBOA innovation for hemorrhage control | N/A — hysterectomy standard | REBOA innovation focused on hysterectomy safety | REBOA (Resuscitative Endovascular Balloon Occlusion) pioneer |
Click any hospital name above to view their full profile page with detailed physician information, outcomes data, and contact details.
Other Notable PAS Centers
The following institutions are excellent PAS programs with strong outcomes — but their primary approach is optimized cesarean hysterectomy rather than fertility preservation. If you are NOT seeking fertility preservation, these centers offer world-class PAS surgical care.
These programs do not offer documented fertility preservation for PAS. If preserving your uterus is a priority, focus on the Top 10 hospitals above.
- Key specialists: Dr. Arthur Jason Vaught and Dr. Torre Halscott
- Monthly PAS multidisciplinary conference for case planning and review
- Exceptionally low ICU admission rate among PAS patients — reflecting superior perioperative management
- Dual-board certified specialists in both MFM and critical care
- Program lead: Dr. Jennifer Gilner (since 2016)
- Transfusion rate of 14.8% compared to the national average of 46.9% — dramatically superior blood management outcomes
- Member of the PAS2 board of directors (national PAS research consortium)
- Data-driven approach with published outcomes that rank among the best in the nation
- Consistently named to U.S. News & World Report Best Hospitals Honor Roll
- Participates in COMPASS surgical data transparency initiative — publicly reporting surgical outcomes
- Comprehensive MFM services with access to the full resources of Mass General Brigham system
UCSF Health — MAPS Program
- MAPS (Multidisciplinary Approach to the Placenta Service) — a named, dedicated PAS program
- Part of the UC Fetal Consortium PAS Working Group, a collaboration across 5 University of California institutions
- Access to the full academic medical center resources of UCSF, including research and clinical trial opportunities
- Named Placenta Accreta Spectrum Program with a dedicated multidisciplinary team
- Utilizes REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) technology for hemorrhage control — a cutting-edge approach to managing massive bleeding
- Multidisciplinary specialists across MFM, gynecologic oncology, interventional radiology, and anesthesiology (program describes providers across more than 10 specialty areas)
International Hospitals & Research Centers
PAS care has advanced significantly thanks to international collaboration. Many of the most important innovations in fertility-preserving surgery originated outside the United States. The following institutions represent the global frontier of PAS research, innovation, and clinical excellence, organized by country.
The International Network of Obstetric Survey Systems (INOSS) connects researchers across 17 countries to study rare obstetric conditions including PAS. Through INOSS, population-level data from multiple nations can be pooled to study PAS incidence, risk factors, management patterns, and outcomes at a scale no single institution could achieve.
France — Pioneer of Leaving Placenta In Situ
France is the global leader in conservative management of PAS — the approach that aims to preserve the uterus and future fertility by leaving the placenta in place when surgical removal would carry excessive risk. French institutions have produced the most significant population-level data on PAS outcomes and have shaped international guidelines.
CHU de Bordeaux
- Lead Physician: Prof. Loïc Sentilhes
- Led the PACCRETA study (176 hospitals, 520,114 deliveries) — the landmark prospective population-based PAS study
- 86 conservative management cases: only 16.3% needed >4 unit transfusion vs. 59% in the hysterectomy group22
- 88.9% subsequent pregnancy rate after conservative treatment40
- Co-author of the FIGO consensus guidelines on PAS management
PMID: 34914894
Hôpital Armand Trousseau (AP-HP)
- Lead Physician: Prof. Gilles Kayem
- Co-PI of PACCRETA study — designed and led the first prospective, population-based study of PAS outcomes
- Approximately 78% uterine preservation rate in conservatively managed cases
- Published comparative data: France vs. UK management showing significantly different conservative management rates
United Kingdom
St George’s University Hospitals
- Key Physicians: Pinas-Carrillo, Bhide, Thilaganathan; Triple-P technique originated by Chandraharan42
- 50 patients, 100% uterine preservation, 0 hysterectomies — one of the most remarkable published outcomes in PAS surgery23
- Uses the Triple-P Procedure: perioperative placental localization, pelvic devascularization, and placental non-separation with myometrial excision and reconstruction
PMID: 31593302
University College London Hospital (UCLH)
- Lead Physician: Prof. Eric Jauniaux — one of the most published PAS researchers in the world
- 480+ peer-reviewed publications in obstetrics, including extensive work on placental disorders and PAS44
- Lead author of the 2025 Nature Reviews Disease Primers comprehensive PAS review — the most authoritative current reference on PAS pathophysiology, diagnosis, and management
- Developed the RCOG Green-top Guideline 27 on placenta praevia and accreta
- Key contributor to the FIGO classification system for PAS
King’s College Hospital
- Led by Dr. Devi Subramanian
- NHS England specialist commissioned regional PAS service — designated by the national health system as a specialist referral center for PAS in the South of England
- Home to the Fetal Medicine Research Institute — one of the world’s leading fetal medicine research centers
Argentina — Pioneer of One-Step Conservative Surgery
CEMIC / CYMSA Buenos Aires
- Lead Physician: Dr. Jose M. Palacios-Jaraquemada — pioneer of one-step conservative surgery for PAS
- 326 confirmed PAS cases across 12 hospitals (multicenter study), approximately 80% avoided hysterectomy24
- Preservation rates by type: Type 1: 81.5%, Type 2: 47.7%, Type 3: 21.8%
- Co-led the first-ever multicenter feasibility RCT of one-step conservative surgery vs. hysterectomy (Nieto-Calvache et al. 2024; 3-country trial: Colombia, Indonesia, Argentina): 85.3% conservative surgery possible25
- One of the longest-running fertility-preservation programs globally, with over two decades of experience
Vietnam
Tu Du Hospital
- Key Researchers: Vuong et al.
- 217 cases, 88.9% uterine preservation — one of the highest-volume PAS centers globally26
- Developed the MOSCUS technique (Modified One-Step Conservative Uterine Surgery)
- One of the highest-volume single-institution PAS centers in the world
PMID: 38009657
China
First Affiliated Hospital of Zhengzhou University
- 883 patients undergoing conservative surgery (2011–2019) — the largest single-institution published series in the world27
- Uses a modified Triple-P technique adapted for their high-volume setting
- Provides crucial data on conservative management outcomes at a scale unmatched elsewhere
PMID: 37832645
Egypt
Tanta University Hospitals
- Key Researcher: Shehata
- 91 cases, 94.5% uterine preservation using a three-step surgical technique28
- Three-step approach includes: vascular control, placental removal, and myometrial reconstruction
PMID: 30316906
Israel
Hadassah-Hebrew University Medical Center
- 134 women managed conservatively — one of the largest conservative management cohorts outside France45
- Approximately 60% fully successful conservative management outcomes
- Long-term follow-up demonstrates fertility not affected long-term in successfully managed patients
Japan
Mie University Hospital
- Developed the TURIP technique (Tourniquet, Uterus Inversion, and Placental dissection) for conservative PAS surgery29
- Single published case report with 100% uterine preservation (n=1)
- Novel technique contribution to the growing global toolkit for fertility-preserving PAS surgery
PMID: 37254306
Singapore
KK Women’s and Children’s Hospital
- 10 conservative vs. 10 hysterectomy — matched comparison study30
- 100% uterine preservation in the conservative surgery group
- Demonstrates feasibility of conservative approach even in smaller-volume settings with rigorous case selection
PMID: 36641463
Global Management Statistics
Management approaches for PAS vary dramatically by country and region. The following table summarizes published hysterectomy and conservative management rates from key national studies, illustrating the wide variation in treatment philosophy worldwide.
| Country | Hysterectomy Rate | Conservative Rate | Key Study |
|---|---|---|---|
| United States | ~70% | ~30% | Silver MFMU 2015 (institutional estimate; specific PMID not identified) |
| France | ~42% | ~58% in situ | PACCRETA 202222 |
| United Kingdom | ~43% | ~19% preserving | McCall et al. BJOG 202246 |
| Argentina | ~20–30% | ~70–80% preservation | Palacios-Jaraquemada 202224 |
| Italy | ~100% (percreta) | 0% | McCall et al. BJOG 2025 (INOSS)47 |
Direct comparison between countries is difficult because of differences in PAS classification, case severity mix, healthcare systems, and study methodologies. However, the general trend is clear: countries where conservative management is systematically offered have significantly lower hysterectomy rates. This does not mean conservative management is always superior — patient selection, surgical expertise, and follow-up protocols are critical factors.
Fertility Preservation: Head-to-Head Comparison
The following table compares 9 hospitals that offer or are developing fertility-preserving PAS care, with hospitals ordered left-to-right by strength of published fertility-specific data. This is meant to help patients and families make informed comparisons — but direct comparison between centers is inherently limited (see caveats below).
| Variable | CEMIC Buenos Aires | Tu Du Hospital | CHU de Bordeaux | UTHealth Houston | Univ. of Utah | Baylor / Texas Children’s | Penn Medicine | Brigham and Women’s | BIDMC / NECPD |
|---|---|---|---|---|---|---|---|---|---|
| Lead Physician | Dr. Jose M. Palacios-Jaraquemada | Vuong ADB et al. | Prof. Loïc Sentilhes | Dr. Farah Amro | Dr. Brett Einerson; Dr. Robert Silver | Dr. Alireza Shamshirsaz; Dr. Michael Belfort | Dr. Beth Pineles | Dr. Daniela Carusi | Dr. Scott Shainker |
| Country | 🇦🇷 Argentina | 🇻🇳 Vietnam | 🇫🇷 France | 🇺🇸 United States | 🇺🇸 United States | 🇺🇸 United States | 🇺🇸 United States | 🇺🇸 United States | 🇺🇸 United States |
| Surgical Approach | Strategy A: Resective-Reconstructive Surgery | Strategy A: MOSCUS | Strategy B: Leaving Placenta In Situ | Strategy B: Leaving Placenta In Situ | Strategy B/C: Individualized Conservative | Emerging fertility-preserving approach | Strategy B: Leaving Placenta In Situ + UAE | Case-by-case individualized approach | Conservative management offered (details unpublished) |
| Published PAS Case Volume | 326 confirmed (452 suspected), 12 hospitals | 296 total (217 MOSCUS + 79 hysterectomy) | 86 (PACCRETA); 167 (Sentilhes 2010) | 180 total (2015–2024) | 44 cases/year; 60–70 consults/year | 243 confirmed (2011–2018; hysterectomy-focused)39 | 11 preservation cases published (from prior institution)35 | 30–50 PAS cases/year (institutional estimate) | Not published as center-specific volume |
| Fertility-Specific Cases | 326 (all attempted preservation) | 217 | 86 (PACCRETA) / 167 (French multicenter historical) | 29 planned preservation | Not published (NICHD study ongoing) | Not published (hysterectomy-focused program) | 11 (at UTHealth Houston, not Penn)35 | Not published as center-specific count | Not published |
| Uterine Preservation Rate | ~80% overall (81.5% Type 1, 47.7% Type 2, 21.8% Type 3)24 | 88.9% (193/217)26 | 78.4% (131/167) (French multicenter)40 | 45% (13/29)17 | ~80% (institutional website; only 6-patient imaging series published)37 | — Not published (hysterectomy-focused) | 55% (6/11) — at prior institution35 | — Not published | — Not published |
| Median Blood Loss (EBL) | 500 mL (Type 1) | 1,000 mL (MOSCUS) vs 1,500 mL (hysterectomy) | Median 1.0 L (France INOSS data) | 700 mL (successful) vs 1,950 mL (failed) | Not published | Median 1,500 mL (hysterectomy data)34 | 650 mL median at cesarean (at prior institution)35 | Not published center-specific | Not published center-specific |
| Transfusion Rate | Lower than hysterectomy group | RBC 500 mL (MOSCUS) vs 710 mL (hysterectomy) | >4 units: 16.3% (conservative) vs 59.0% (hysterectomy) | 31% (successful) vs 73% (failed) | Cell salvage standard; no rate published | Median 1 unit RBC (hysterectomy data)34 | Not published | Not published center-specific | Not published center-specific |
| Subsequent Pregnancies Published | 202 cases studied41 | Not published | 24/27 (88.9%) conceived; 34 pregnancies40 | 5 healthy pregnancies, 0% recurrence17 | NICHD study collecting data | Not published center-specific | 4 patients, 3 live births, 1 miscarriage (at prior institution)35 | 39 patients returned for subsequent delivery36 | Not published center-specific |
| Term Delivery Rate | 90% (162/179) at term | Not published | 21 healthy term deliveries | 5/5 healthy births | NICHD study collecting data | Not published center-specific | 3/4 (75%) (at prior institution)35 | Not published center-specific | Not published center-specific |
| PAS Recurrence Rate | 0% in published series41 | Not published | 28.6% (6/21) | 0% (5 patients) | 11.8% pooled (meta-analysis, not center-specific)38 | Not published center-specific | Not published | 25–35% (cited by lead physician; no published source identified) | Not published center-specific |
| Key Complications | 20% require hysterectomy; Type 3–4 less amenable | 11.1% secondary hysterectomy; higher postop infection (p=0.012) | Endometritis 10.8%, readmission 28.9%, UAE 24.7% | 55% conversion to hysterectomy | ~20% delayed hysterectomy (institutional claim) | Hysterectomy outcomes improved over time34 | 5/11 required hysterectomy (endomyometritis, hemorrhage) (at prior institution)35 | Not published center-specific | No center-specific outcomes published |
| Years of Experience | 20+ years | High-volume center (619 PAS in 2 years) | 20+ years | ~10 years (2015–2024) | 15+ years | 15+ years | ~3 years at Penn (est. 2023); PI trained at UTHealth Houston | Established high-volume program | ~10 years (est. ~2014) |
| Active Clinical Trials | Co-led first RCT (NCT05013749) | None registered | None currently listed | None currently listed | NICHD K23HD106009 | None listed for fertility preservation | U-PRESERVE (NCT06512181) | None listed | None listed |
| Key Publications | PMID: 31984808, 33843411, 38458362 | PMID: 38009657 | PMID: 34914894, 20177283, 20833739 | PMID: 40273455 | PMID: 36717353, 40373321 | PMID: 25173187, 28213059, 31173748 | PMID: 35752168 (at UTHealth), 36113717 | PMID: 28079779 (subsequent pregnancy study) | PMID: 35065016 (commentary); no center-specific outcomes |
Penn Medicine: All published preservation outcome data (11-patient case series, 55% rate) was generated at UTHealth Houston before Dr. Pineles moved to Penn.35 Penn has no center-specific published outcomes yet; the U-PRESERVE trial (NCT06512181) is actively recruiting.
University of Utah: The ~80% preservation rate appears on the institutional website but is not yet supported by a peer-reviewed outcomes publication. The only published study is a 6-patient imaging case series.37 NICHD-funded research (K23HD106009) is ongoing.
Baylor / Texas Children’s: Published data focuses on cesarean hysterectomy optimization (Belfort-Fox technique), not fertility preservation. Blood loss and transfusion data in this table are from their hysterectomy program.34
BIDMC / NECPD: No center-specific preservation outcomes have been published. Dr. Shainker’s publications focus on commentaries, pathologic classification, and patient experience research.
Inside the United States: UTHealth Houston — The only US center with published, peer-reviewed, center-specific uterine preservation outcome data. 180-patient cohort, 45% preservation rate (13/29 who elected preservation), 5 subsequent healthy pregnancies with 0% PAS recurrence.17 The University of Utah is a strong alternative with NICHD-funded research (K23HD106009) and claims ~80% preservation on their institutional website, but as of March 2026 the only peer-reviewed publication is a 6-patient imaging case series37 — larger outcomes data are anticipated.
Outside the United States: CEMIC Buenos Aires, Argentina — Largest published fertility-preserving case series worldwide (326 confirmed PAS cases, ~80% preservation rate). Co-led the first-ever multicenter feasibility RCT comparing conservative surgery to hysterectomy (Nieto-Calvache et al., 3-country trial).25 Published data on 202 subsequent pregnancies with 90% term delivery rate and 0% PAS recurrence — the strongest published fertility outcome data of any center globally.41
Direct comparison between these hospitals is inherently limited by several factors: (1) Selection bias — centers that attempt more conservative management may select less severe cases; (2) Different PAS severity mix — some centers primarily manage accreta while others manage more percreta cases; (3) Different outcome definitions — “preservation rate” may be defined differently across studies; (4) Different follow-up periods — some have 20+ years of data while others have <5 years; (5) Publication bias — centers with better results may be more likely to publish; (6) Healthcare system differences — costs, access, and standard practices vary dramatically by country. Use this table as a starting point for research, not as a definitive ranking.3132
While conservative management can preserve fertility, it carries significant risks that patients must understand. According to the 2025 Nature Reviews Disease Primers comprehensive review,44 complications of the leaving-placenta-in-situ approach include:
- Infection: chronic bleeding, endometritis, sepsis, septic shock, peritonitis
- Organ damage: uterine necrosis, fistula formation, acute renal failure
- Vascular: deep venous thrombosis, pulmonary embolism, acute pulmonary oedema
- Treatment failure: delayed hysterectomy may still be required in 20–55% of cases depending on severity and center experience
Recurrence rates vary by technique: A 2024 meta-analysis found an overall pooled PAS recurrence rate of 11.8% across 16 studies,38 while the Nature Reviews paper cites >20% overall recurrence risk.44 However, outcomes differ significantly by approach: CEMIC’s resective-reconstructive surgery (Strategy A — which fully excises affected myometrium) reports 0% recurrence in 202 subsequent pregnancies,41 while the leaving-in-situ approach (Strategy B) has higher recurrence rates because placental tissue remains. This distinction matters — not all “conservative management” carries the same risk profile.
How to Choose a Hospital
Choosing the right hospital for your PAS delivery is one of the most impactful decisions you can make. Here is a framework to guide your evaluation.
Questions to Ask Your Potential Care Team
- How many PAS cases does this hospital manage per year? Higher volume generally correlates with better outcomes.
- Is there a dedicated PAS or abnormal placentation program? Named, dedicated programs tend to have more refined protocols.
- Who will be on my surgical team? Look for a multidisciplinary team (MDT) that includes MFM, gynecologic oncology or experienced pelvic surgeons, anesthesiology, interventional radiology, neonatology, urology, and a blood bank coordinator.
- What is your transfusion rate for PAS cases? Lower transfusion rates can indicate superior surgical technique and planning.
- Do you use cell salvage (intraoperative blood recovery)? This technique can significantly reduce the need for donor blood transfusions.
- What level NICU do you have? Level III or IV NICUs are preferred, especially for planned preterm deliveries.
- Do you offer fertility-preserving approaches? If future fertility is important to you, ask about conservative management options and the team’s experience with them.
- Can I see published outcomes data? Centers with transparent, published outcomes demonstrate confidence in their results and commitment to quality improvement.
- What happens in an emergency? Ask about rapid-response protocols, operating room availability, and massive transfusion protocols.
- Will the same team manage my entire care? Continuity of care from diagnosis through delivery and recovery is a hallmark of excellent PAS programs.
What to Look For
The National Accreta Foundation maintains a hospital guide and patient resources that can help you identify PAS-experienced centers near you. Visit preventaccreta.org for their latest hospital directory, patient support programs, and educational materials.
References
References
- American College of Obstetricians and Gynecologists (ACOG). Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259–e275. acog.org
- Jauniaux E, Bunce C, Grônbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(3):208–218.
- Einerson BD, et al. Placenta accreta spectrum disorder: uterine dehiscence, not placental invasion. Obstet Gynecol. 2021;137(6):1029–1036.
- Fox KA, et al. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2020;222(5):e1–e14.
- Sentilhes L, Kayem G, et al. Conservative management of placenta accreta spectrum. Clin Obstet Gynecol. 2018;61(4):783–794.
- Kayem G, Seco A, et al. PACCRETA: Clinical situations at high risk of placenta accreta/invasive placenta — a population-based study. Acta Obstet Gynecol Scand. 2019;98(8):1063–1073.
- Jauniaux E, Grônbeck L, Bunce C, et al. Epidemiology of placenta previa accreta: a systematic review and meta-analysis. BMJ Open. 2019;9(11):e031193.
- Gilner JB, et al. Multidisciplinary team approach for placenta accreta spectrum: outcomes from a single institution. Am J Perinatol. 2020;37(14):1464–1470.
- Carusi DA. The Placenta Accreta Spectrum: Epidemiology and Risk Factors. Clin Obstet Gynecol. 2018;61(4):733–742.
- Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018;378(16):1529–1536.
- FIGO Safe Motherhood and Newborn Health Committee. FIGO consensus guidelines on placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140(3):281–298.
- National Accreta Foundation. Hospital Guide and Resources. preventaccreta.org
- UC Health. Level IV Maternity Services — University of Cincinnati Medical Center. uchealth.com
- RCOG Green-top Guideline No. 27a: Placenta Praevia and Placenta Accreta: Diagnosis and Management. rcog.org.uk
- Collins SL, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47(3):271–275.
- International Network of Obstetric Survey Systems (INOSS). npeu.ox.ac.uk/inoss
- Amro F, et al. Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder. Obstet Gynecol. 2025;145(6). PMID: 40273455
- Pineles BL, et al. Is conservative management of placenta accreta spectrum practical in the United States? AJOG MFM. 2023. PMID: 36113717
- [Reference removed — original PMID 39217925 was incorrectly attributed; the meta-analysis on conservative management vs. cesarean hysterectomy (974 mL less blood loss) is correctly cited as ref-31 (Hessami et al., PMID 39884567).]
- Paping RHL, Fox KA, et al. Opportunities for, and barriers to, uterus-preserving surgical techniques for placenta accreta spectrum. Acta Obstet Gynecol Scand. 2025;104(4):686–695. PMID: 38695676
- Shamshirsaz AA, et al. Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time. Am J Obstet Gynecol. 2017. PMID: 28213059
- Sentilhes L, Kayem G, et al. Conservative management of placenta accreta spectrum in the PACCRETA prospective study: 86 conservative cases with outcomes. Am J Obstet Gynecol. 2022. PMID: 34914894
- Pinas-Carrillo A, Bhide A, Thilaganathan B. Placenta accreta spectrum: perioperative management and surgical techniques. Int J Gynaecol Obstet. 2020;148(1):65–71. PMID: 31593302
- Palacios-Jaraquemada JM, et al. One-step conservative surgery for abnormally invasive placenta (placenta accreta spectrum): resective-reconstructive approach in a multicenter study of 326 confirmed cases. J Matern Fetal Neonatal Med. 2022;35(2):275–282. PMID: 31984808. Note: This was a multicenter study across 12 hospitals, not a single-center series.
- Nieto-Calvache AJ, Palacios-Jaraquemada JM, et al. Randomized controlled trial of one-step conservative surgery vs. hysterectomy for placenta accreta spectrum. 2024. PMID: 38458362
- Vuong NL, et al. Modified one-step conservative uterine surgery (MOSCUS) for placenta accreta spectrum: 217 cases with 88.9% uterine preservation. 2024. PMID: 38009657
- Li N, et al. Subsequent pregnancy outcomes and risk factors following conservative treatment for placenta accreta spectrum. First Affiliated Hospital of Zhengzhou University; 883 patients (2011–2019). 2023. PMID: 37832645
- Shehata A. Three-step technique for conservative management of placenta accreta spectrum: 91 cases with 94.5% uterine preservation. J Gynecol Obstet Hum Reprod. 2019;48(3):199–203. PMID: 30316906
- Mie University Hospital. TURIP technique for conservative surgery in placenta accreta spectrum. 2023. PMID: 37254306
- KK Women’s and Children’s Hospital Singapore. Conservative surgery vs. hysterectomy for placenta accreta spectrum: matched comparison of 10 vs. 10 cases. 2023. PMID: 36641463
- Hessami K, et al. Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025. PMID: 39884567
- Futterman ID, et al. Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis. Am J Perinatol. 2025. PMID: 39732143
- Matsuzaki S, et al. Local Resection After Cesarean Delivery for Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025. PMID: 40245405
- Shamshirsaz AA, et al. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol. 2018;131(2):234-241. PMID: 29324609
- Pineles BL, et al. Leaving the placenta in situ in placenta accreta spectrum disorders: a single-center case series. Am J Perinatol. 2024. PMID: 35752168. Note: This study was conducted at UTHealth Houston prior to Dr. Pineles’ move to Penn Medicine.
- Roeca C, Little SE, Carusi DA. Pathologically diagnosed placenta accreta and hemorrhagic morbidity in a subsequent pregnancy. Obstet Gynecol. 2017;129(2):321–326. PMID: 28079779
- Griffith AM, Dalton ME, Kennedy MR, Woodward PJ, Einerson BD. Clinical and radiologic evolution in conservative management of placenta accreta spectrum disorder. Obstet Gynecol. 2025;145(6):739–748. PMID: 40373321. 6-patient imaging case series.
- Javinani A, et al. Subsequent pregnancy outcomes after conservative management of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol. 2024;230(5):485-492.e7. PMID: 37918506
- Erfani H, Fox KA, Clark SL, Rac M, et al. Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team. Am J Obstet Gynecol. 2019. 243 patients (2011–2018). PMID: 31173748
- Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115(3):526–534. PMID: 20177283. French multicenter study; 167 cases with 78.4% preservation rate.
- Palacios-Jaraquemada JM, et al. Subsequent reproductive outcomes in patients managed with conservative surgery for placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol. 2021;261:30–34. PMID: 33843411. 202 subsequent pregnancies with 0% PAS recurrence.
- Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2012;117(2):191–194. PMID: 22326782. Original description of the Triple-P procedure at St George’s Hospital.
- Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212(2):218.e1–218.e9. PMID: 25173187
- Jauniaux E, et al. Placenta accreta spectrum. Nat Rev Dis Primers. 2025;11(1):7. doi: 10.1038/s41572-025-00624-3. Comprehensive 2025 primer on PAS pathophysiology, diagnosis, and management.
- Hadassah-Hebrew University Medical Center. Conservative management of placenta accreta spectrum: long-term outcomes. PMID: 36388196 (likely source for 134-patient conservative management cohort).
- McCall SJ, Bhatt M, Engel ME, et al. Treatment of placenta accreta spectrum: an international comparison of practice. BJOG. 2022;129(10):1671–1680. PMID: 35384244. UK vs France comparative data.
- McCall SJ, et al. Management and outcomes of placenta accreta spectrum grade 3 (placenta percreta): an international cohort study. BJOG. 2025. PMID: 40197338. INOSS multicountry data on percreta management.