Brigham and Women’s Hospital

Program Overview

Brigham and Women’s Hospital (BWH) is a principal teaching affiliate of Harvard Medical School and one of the nation’s leading academic medical centers. Located in Boston’s Longwood Medical Area, BWH has built a nationally recognized PAS program that combines high surgical volume with innovative research and a commitment to individualized patient care.

The program manages approximately 30–50 PAS cases per year, placing it among the highest-volume PAS centers in the country and earning a #5 national ranking among US PAS centers. BWH is distinguished by its use of a hybrid operating room — a specially equipped surgical suite that combines advanced imaging capabilities with a full surgical environment. This allows the interventional radiology team to place balloon catheters and perform embolization procedures without transporting the patient, reducing delays and improving hemorrhage control during PAS surgery.

The hospital’s PAS program is embedded within a strong maternal-fetal medicine research infrastructure, with faculty leading multicenter studies and contributing to national guidelines on PAS management. BWH is part of the Mass General Brigham health system, which provides access to system-wide resources and expertise across its network of hospitals.

Fertility Preservation Status

Surgical and Anesthesia Data

In a study of 129 nonemergent cesarean deliveries for PAS at BWH, 72 of 129 (56%) required hysterectomy. Anesthesia management data showed that 95% of patients received neuraxial anesthesia (spinal or epidural), and among those who required hysterectomy, 21% needed conversion to general anesthesia during the procedure.5

Subsequent Pregnancy Outcomes After Uterine Preservation

A systematic review published by BWH investigators examined outcomes for patients who preserved their uterus after PAS and went on to have subsequent pregnancies. Among 39 patients with preserved fertility who had subsequent pregnancies, the study found:5

• 11.8% PAS recurrence rate
• 10.3% postpartum hemorrhage (PPH) rate
• 22.7% composite adverse outcome rate

These data provide important reassurance — and important caution — for patients who successfully preserve their uterus and wish to pursue additional pregnancies.

Conservative management at BWH involves a carefully individualized approach. After cesarean delivery, the placenta may be left in situ, with patients monitored through serial imaging and laboratory studies. Candidacy depends on the depth and extent of placental invasion, maternal hemodynamic stability, and patient reproductive goals. Patients considering this option should discuss the expected timeline, monitoring requirements, and the possibility that delayed hysterectomy may still be necessary with their care team. The program coordinates with reproductive endocrinology specialists for patients who may need assisted reproductive technology (ART) support.

Key Physicians

Multidisciplinary Team Composition

PAS cases at BWH are managed by a comprehensive multidisciplinary team that includes:

• Maternal-Fetal Medicine (MFM) — overall care coordination, prenatal monitoring, delivery planning, and conservative management oversight
• Gynecologic Oncology — surgical expertise in complex pelvic dissection, particularly for cases with deep myometrial or parametrial invasion
• Interventional Radiology — integrated into the hybrid OR for real-time balloon catheter placement and uterine artery embolization during surgery
• Urology — management of bladder and ureteral involvement, which occurs in a significant proportion of percreta cases
• Obstetric Anesthesiology — dedicated team led by Dr. Michaela Farber with specialized training in massive hemorrhage management and PAS-specific anesthetic protocols
• Blood Bank / Transfusion Medicine — massive transfusion protocol coordination, cell salvage technology, and comprehensive blood product availability
• Neonatology — Level IV NICU providing the highest level of neonatal care, including surgical capabilities for the most complex newborn cases
• Social Work — psychosocial support for patients and families navigating a PAS diagnosis
• Nursing Specialists — experienced obstetric and surgical nursing staff trained in PAS case protocols

Published Outcomes

BWH has contributed significantly to the PAS literature, with a particular focus on comparing management strategies and advancing the evidence base for conservative treatment.

Conservative vs. Hysterectomy Meta-Analysis (AJOG 2025)

The landmark meta-analysis led by Dr. Shainker and colleagues systematically compared outcomes of conservative management (leaving the placenta in situ) versus primary cesarean hysterectomy for PAS. The study found that conservative management was associated with 974 mL less estimated blood loss on average compared to hysterectomy. This represents one of the most rigorous comparative analyses of PAS management strategies published to date and has informed clinical decision-making at centers worldwide.1

Surgical Obstetrics Outcomes

Under Dr. Carusi’s leadership, BWH has published on surgical outcomes in PAS, contributing data on operative techniques, blood loss, transfusion requirements, and complications. These studies help define benchmarks for PAS surgical care at high-volume centers and support the program’s individualized approach to management decisions.2

Multicenter Research Contributions

BWH serves as a major site for multicenter PAS studies, contributing patient data and clinical expertise to collaborative efforts aimed at improving PAS diagnosis, management, and outcomes across institutions. The hospital’s affiliation with Harvard Medical School provides access to a robust research infrastructure that supports both clinical and translational investigation.3

Clinical Trials

BWH is actively involved in PAS research, with ongoing and planned investigations including:

• Comparative effectiveness studies of conservative management vs. hysterectomy
• Fertility outcomes following conservative PAS management
• Optimization of hybrid OR protocols for PAS surgery
• Multicenter studies on PAS imaging, diagnosis, and risk stratification
• Maternal and neonatal outcomes at high-volume PAS centers

Patients interested in participating in PAS-related research studies should ask their MFM provider about currently enrolling protocols. Clinical trial information can also be searched at ClinicalTrials.gov using the terms “placenta accreta” and “Brigham and Women’s Hospital.”

Practical Information

Contact

• Hospital: Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115
• Department: Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology
• Phone: 617-732-5500 (main); request Maternal-Fetal Medicine for PAS referrals
• Website: brighamandwomens.org

Insurance

BWH accepts most major insurance plans. As part of the Mass General Brigham system, coverage may vary depending on your specific plan and network. Contact the hospital’s patient financial services or your insurance provider to verify coverage before scheduling, especially for out-of-state patients. Given the complexity and cost of PAS care, early engagement with financial services is recommended to obtain pre-authorization and plan for potential out-of-network costs.

Telemedicine

Mass General Brigham offers virtual visits through its patient portal. Initial PAS consultations may be available via telemedicine for patients traveling from a distance, though in-person evaluation will be needed for imaging and surgical planning. This is particularly valuable for out-of-state patients seeking a second opinion on management options. Ask about telemedicine options when scheduling your appointment.

Travel

BWH is located in the Longwood Medical Area of Boston, approximately 20–30 minutes from Logan International Airport depending on traffic. The hospital is accessible by public transit (MBTA Green Line, Longwood Medical Area stop) and offers on-site parking. The Longwood area has extensive nearby lodging options, and the hospital can assist with patient housing resources for those relocating for the final weeks of pregnancy.

References