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CHU de Bordeaux — Bordeaux University Hospital

Home of the landmark PACCRETA study and a world leader in conservative PAS management with the leaving-placenta-in-situ approach

Last reviewed: March 2026

Key Takeaways

  • Led the PACCRETA study — the first prospective, population-based study of PAS management across 176 hospitals and 520,114 deliveries1
  • 86 conservative management cases in PACCRETA; only 16.3% needed >4 unit transfusion vs. 59% in the hysterectomy group
  • 78.4% uterine preservation rate in the Sentilhes 2010 French multicenter series of 167 cases2
  • 88.9% subsequent pregnancy rate among women who attempted conception — French multicenter data3
  • Prof. Sentilhes is a co-author of the FIGO consensus guidelines on PAS management5

Program Overview

CHU de Bordeaux (Centre Hospitalier Universitaire de Bordeaux) is a major French university hospital and national referral center for high-risk obstetric conditions, including placenta accreta spectrum. Located in southwestern France, the hospital is part of the French public university hospital system and serves as a tertiary referral center for the Nouvelle-Aquitaine region.

Under the leadership of Prof. Loïc Sentilhes, the Bordeaux team has produced some of the most significant population-level data on conservative PAS management in the world. Their work has fundamentally shaped the evidence base for the leaving-placenta-in-situ approach and has influenced international practice guidelines.

France as a whole has been at the forefront of conservative PAS management, with national data showing that approximately 58% of PAS cases are managed conservatively (placenta left in situ), compared to roughly 70% hysterectomy in the United States. This systematic national commitment to conservative management has generated the largest prospective datasets on outcomes of this approach.

Fertility Preservation Status

✅ Fertility Preservation Offered — World Leader

CHU de Bordeaux, under Prof. Sentilhes, is a global leader in conservative PAS management using the Strategy B: Leaving Placenta In Situ approach. The Sentilhes-led French multicenter series demonstrated a 78.4% uterine preservation rate across 167 cases from multiple French centers, and an 88.9% subsequent pregnancy rate (24 of 27 women who attempted conception successfully became pregnant, resulting in 34 total pregnancies). The Bordeaux-led PACCRETA study prospectively enrolled 86 conservative management cases from 176 hospitals.12

Management Strategy

Strategy B: Leaving Placenta In Situ (Expectant/Conservative Management) — After cesarean delivery, the cord is ligated and the placenta is left in place. The patient is monitored with serial imaging, laboratory testing, and clinical follow-up. The placenta typically resorbs over weeks to months. Uterine artery embolization (UAE) may be used adjunctively to reduce blood supply to the retained placenta.1

PACCRETA Study: Prospective Outcomes (2022)

The PACCRETA study was a landmark prospective, population-based cohort study conducted across 176 French hospitals encompassing 520,114 deliveries. Key outcomes for the 86 conservatively managed cases:1

Outcome Conservative (n=86) Hysterectomy (n=62)
Transfusion >4 units 16.3% 59.0%
UAE performed 24.7% —
Endometritis 10.8% 0%
Hospital readmission 28.9% 3.4%

Sentilhes 2010 Series: Fertility Outcomes (French Multicenter Data)

In a French multicenter series of 167 conservatively managed patients (led by Sentilhes from Bordeaux but including data from multiple French centers), the team reported:2

  • 131 of 167 (78.4%) achieved uterine preservation
  • Of 27 women who attempted subsequent pregnancy, 24 (88.9%) conceived
  • 34 total pregnancies reported, including 21 healthy term deliveries
  • PAS recurrence: 28.6% (6/21) in subsequent pregnancies
⚠ Important: Recurrence Risk

The Sentilhes 2010 data showed a 28.6% PAS recurrence rate in subsequent pregnancies after conservative management. This is consistent with the international literature reporting 22-29% recurrence. All patients who preserve their uterus should be counseled about this risk and receive close surveillance in any subsequent pregnancy.3

Key Physicians

Prof. Loïc Sentilhes, MD, PhD

Head of Obstetrics, CHU de Bordeaux

Prof. Sentilhes is one of the world's foremost experts on conservative management of PAS. He led the PACCRETA study, co-authored the FIGO consensus guidelines on PAS, and has published the most comprehensive fertility outcome data for conservative PAS management. His work over two decades has been instrumental in establishing the evidence base for the leaving-placenta-in-situ approach.15

Prof. Gilles Kayem, MD, PhD

Co-PI, PACCRETA Study (Hôpital Trousseau, Paris)

Prof. Kayem co-designed and co-led the PACCRETA study from Hôpital Armand Trousseau in Paris. He has published comparative data on French vs. UK management approaches and contributed to INOSS international collaboration studies. His research on population-level PAS outcomes has been key to understanding national management patterns.4

Multidisciplinary Team Composition

As a French university hospital, CHU de Bordeaux assembles a comprehensive multidisciplinary team for PAS management, including:

  • Obstetrics / Maternal-Fetal Medicine — primary surgical and clinical management led by Prof. Sentilhes
  • Anesthesiology — specialized obstetric anesthesia protocols for high-risk deliveries
  • Interventional Radiology — for uterine artery embolization (UAE), used in approximately 25% of conservative cases
  • Urology — for cases with bladder involvement
  • Neonatology — Level III neonatal intensive care
  • Hematology / Blood Bank — transfusion medicine and massive transfusion protocols
  • Pathology — for histological confirmation and classification of PAS

Published Outcomes

The Bordeaux team's contributions to PAS literature include some of the most cited studies in the field:

PACCRETA Prospective Study (2022)

The PACCRETA study remains the only prospective, population-based study of PAS outcomes across an entire national healthcare system. Covering 176 hospitals and 520,114 deliveries, it provided definitive evidence that conservative management is associated with significantly lower transfusion requirements compared to primary hysterectomy in appropriately selected cases.1

Fertility Outcomes (Sentilhes 2010)

The 2010 Human Reproduction study remains the most comprehensive published dataset on fertility after conservative PAS management, demonstrating that the majority of women who desire subsequent pregnancy after conservative treatment can achieve it, though with a notable recurrence risk that requires careful counseling and surveillance.3

International Comparisons

Through the INOSS network, the French team has contributed to comparative studies showing dramatically different management patterns across countries — with France having one of the highest rates of conservative management globally (~58% vs. ~30% in the US). These comparisons have been instrumental in demonstrating that conservative management, when systematically offered by experienced teams, is a viable and safe alternative to hysterectomy.4

Practical Information

Location

  • Hospital: CHU de Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
  • Department: Service de Gynécologie-Obstétrique

International Patient Considerations

🌐 For International Patients

CHU de Bordeaux is a French public university hospital. International patients should be aware of the following practical considerations:

  • Language: Clinical care is conducted primarily in French. Interpreters may be available but should be arranged in advance.
  • Healthcare System: France has a public healthcare system. International patients without EU coverage will need to arrange private payment or insurance coverage for treatment in France.
  • Travel: Bordeaux is served by Bordeaux-Mérignac Airport (BOD) with connections to major European hubs. High-speed TGV trains connect Bordeaux to Paris in approximately 2 hours.
  • Referral Process: Contact the hospital's international patient office for referral guidance and appointment scheduling.

Insurance

French public hospitals operate under the national Sécurité Sociale system. Patients covered under the French system or with EU European Health Insurance Cards (EHIC) may have costs covered. US-based patients will typically need to self-pay or seek reimbursement from their insurance provider. Contact the hospital directly for cost estimates.

References

  1. Sentilhes L, Kayem G, et al. Conservative management of placenta accreta spectrum in the PACCRETA prospective study. Am J Obstet Gynecol. 2022. PMID: 34914894
  2. Sentilhes L, Ambroselli C, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115(3):526-534. PMID: 20177283. French multicenter study across 25 institutions.
  3. Sentilhes L, Kayem G, Ambroselli C, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod. 2010;25(11):2803-2810. PMID: 20833739
  4. Kayem G, et al. Specific second-line therapies for postpartum haemorrhage: a multinational cohort study using the INOSS database. BJOG. 2022. PMID: 35384244
  5. FIGO Safe Motherhood and Newborn Health Committee. FIGO consensus guidelines on placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140(3):281-298. PMID: 29405320