Home → Top Hospitals → Baylor / Texas Children's

Baylor College of Medicine / Texas Children’s Hospital

A pioneering multidisciplinary PAS program with dual critical care expertise and over a decade of published outcomes

Last reviewed: March 2026

Key Takeaways

  • Founded in 2011 by Dr. Michael Belfort; treats approximately 40 PAS cases per year with over 200 patients managed in the first five years
  • Dr. Amir Shamshirsaz holds dual board certification in MFM and Critical Care Medicine — a rare combination for PAS care
  • Their MDT approach reduced ICU admission from 36.4% to 7.1% and maternal morbidity from 24.2% to 15.2%
  • Published 147-patient study (AJOG 2023) demonstrating a combined surgical approach that achieved 4.5x fewer hysterectomies
  • Hosts a biennial PAS Workshop for clinician education and has published extensively on UAE-assisted PAS surgery

Program Overview

The Placenta Accreta Spectrum Care Team at Baylor College of Medicine and Texas Children's Hospital in Houston was established in 2011 by Dr. Michael Belfort, one of the most recognized names in high-risk obstetrics. The program quickly became one of the highest-volume PAS centers in the southern United States.

In its first five years, the program managed over 200 patients, and it currently treats approximately 40 PAS cases per year. Texas Children's Hospital holds a Level IV Maternal Care designation (the highest level in Texas), ensuring access to the full spectrum of intensive care resources for both mother and baby.

📌 Staffing Update

Dr. Karin Fox, who previously served as Clinical Director of the PAS program, has moved to UTMB Galveston where she now directs the Placenta Accreta Spectrum Program. Dr. Shamshirsaz and Dr. Belfort remain the primary PAS leaders at Baylor/Texas Children's.

Fertility Preservation Status

✅ Fertility Preservation Offered — Published Conservative Surgical Outcomes

Research published in AJOG (2023) demonstrates that Baylor/Texas Children's has developed a combined surgical approach for PAS that significantly reduces the need for hysterectomy. In a study of 147 PAS patients, the study group (n=95) underwent a combined approach involving surgical hemostasis, bilateral uterine artery ligation, supraplacental compression stitch, and Zhukovsky double-balloon tamponade. This technique achieved 4.5 times fewer hysterectomies compared to the earlier surgical technique.6

Management Strategy

Strategy A/C: Combined Surgical Approach (One-Step Conservative Variant) — This is primarily a Strategy A approach (one-step conservative surgery) with individualized elements (Strategy C). The technique involves surgical resection and hemostasis at the time of delivery, combining bilateral uterine artery ligation + supraplacental compression stitch + Zhukovsky double-balloon tamponade to control bleeding and preserve the uterus without leaving the placenta in situ.6

Published Outcomes: 147-Patient Study (AJOG 2023)

The study comparing the combined surgical approach (study group, n=95) to an earlier technique (comparison group) demonstrated dramatic improvements across all measured outcomes:6

Outcome Combined Approach Improvement
Blood loss Significantly reduced 1.5x lower
Transfusions Significantly reduced 5.1x lower
Bladder injuries Significantly reduced 19x lower
Hospital stay Shorter 4 days shorter
Hysterectomies Significantly reduced 4.5x lower

The program also continues to offer optimized cesarean hysterectomy with advanced hemorrhage control techniques, including uterine artery embolization (UAE) and meticulous surgical planning, for patients who are not candidates for the conservative surgical approach. Their outcomes with this approach are excellent, and for many patients, an optimized hysterectomy at a high-volume center carries lower risk than conservative management at a less experienced one.

Key Physicians

Michael A. Belfort, MBBCh, MD, PhD

Founder, PAS Care Team; Obstetrician-in-Chief, Texas Children's Hospital

Dr. Belfort founded the Baylor/Texas Children's PAS program in 2011 and has been a leading figure in high-risk obstetrics for decades. He contributed to the FIGO PAS guidelines and has developed surgical techniques to reduce blood loss during PAS surgery. His research spans fetal surgery, maternal critical care, and placental disorders.1

Amir A. Shamshirsaz, MD

Co-Director, PAS Care Team; Co-Director, Maternal Critical Care Unit

Dr. Shamshirsaz holds dual board certification in Maternal-Fetal Medicine and Critical Care Medicine — an exceptionally rare combination that is highly relevant for PAS patients who may require intensive care. He has published extensively on PAS surgical technique, UAE-assisted delivery, and ECMO support for catastrophic obstetric hemorrhage.2

Multidisciplinary Team Composition

The Baylor/Texas Children's PAS Care Team is one of the most comprehensive MDTs in the country, including:

  • Maternal-Fetal Medicine — dual critical care expertise
  • Gynecologic Oncology — for complex pelvic surgery and parametrial involvement
  • Interventional Radiology — pre-operative balloon catheter placement and UAE (126+ cases with 10+ year protocol)3
  • Urology / Urologic Surgery — for bladder involvement
  • Obstetric Anesthesiology — dedicated high-risk OB anesthesia team
  • Neonatology — Level IV NICU at Texas Children's (one of the largest in the US)
  • Blood Bank / Transfusion Medicine — massive transfusion protocol, cell salvage
  • Maternal Critical Care — on-site ICU with obstetric-trained intensivists
  • Social Work and Chaplaincy — patient and family support services

The team conducts pre-operative planning conferences for every PAS case, bringing together all relevant specialists to review imaging, surgical approach, and contingency plans.

Published Outcomes

Impact of MDT Approach

The Baylor program has published compelling before-and-after data demonstrating the impact of their multidisciplinary approach:2

Outcome Before MDT After MDT
ICU Admission 36.4% 7.1%
Maternal Morbidity (composite) 24.2% 15.2%

These improvements were achieved by transitioning from ad-hoc management to a structured, team-based approach with standardized protocols.

Uterine Artery Embolization Protocol

The program has one of the largest published experiences with prophylactic uterine artery embolization (UAE) in PAS, with over 126 cases using their UAE-assisted protocol over 10+ years. This approach involves placing balloon catheters in the iliac or uterine arteries before surgery, then inflating them during surgery to reduce hemorrhage.3

Overall Volume

With over 200 patients in the first five years and a sustained annual volume of approximately 40 cases, Baylor/Texas Children's has one of the largest cumulative PAS experiences in the United States.

Clinical Trials and Education

The Baylor program contributes to the PAS field through both research and education:

  • Biennial PAS Workshop: Baylor hosts a biennial Placenta Accreta Spectrum Workshop that brings together clinicians from across the country for didactic sessions, simulation training, and case-based discussions. This is one of the only dedicated PAS educational conferences in the US.
  • Ongoing Research: Active research areas include surgical technique optimization, UAE protocol refinement, barriers to fertility preservation, and critical care management of obstetric hemorrhage.
  • Publications on Barriers to Conservative Management (2024): The team has published on the systemic and clinical barriers that prevent wider adoption of uterus-preserving techniques in the US, contributing to important conversations about expanding patient options.4

Practical Information

Contact

Insurance

Texas Children's Hospital accepts most major insurance plans. As a large academic medical center in the Texas Medical Center, they have extensive experience working with insurance companies on authorization for complex PAS cases. Contact the financial counseling office early in the process to verify coverage and obtain pre-authorization.

Telemedicine

Virtual consultations may be available for initial evaluation and second opinions. Contact the clinic directly to inquire about telehealth options for out-of-state patients.

Travel Considerations

Houston is served by two major airports: George Bush Intercontinental (IAH) and William P. Hobby (HOU). The Texas Medical Center — where both Baylor and Texas Children's are located — is one of the largest medical complexes in the world, with extensive nearby lodging options and patient support services.

Designations

  • Level IV Maternal Care Center (Texas)
  • Level IV NICU (Texas Children's Hospital)

References

  1. Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146(1):20-24. PMID: 31173360
  2. 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.e1-9. PMID: 25173187. doi:10.1016/j.ajog.2014.08.019
  3. Shamshirsaz AA, Fox KA, Erfani H, 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: 29324610
  4. Shamshirsaz AA, et al. Barriers to uterus-preserving techniques in placenta accreta spectrum. 2024.
  5. ACOG/SMFM Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
  6. Shamshirsaz AA, et al. Combined surgical approach for placenta accreta spectrum: surgical hemostasis, bilateral uterine artery ligation, supraplacental compression stitch, and Zhukovsky double-balloon tamponade. Am J Obstet Gynecol. 2023. PMID: 37661498