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Cleveland Clinic

World-class surgical infrastructure with integrated gynecologic oncology collaboration and systematic multidisciplinary PAS management in Cleveland, Ohio

Last reviewed: March 2026

Key Takeaways

  • Ranked #9 among US PAS centers, Cleveland Clinic brings world-class surgical facilities and a systematic multidisciplinary approach to placenta accreta spectrum management
  • Strong gynecologic oncology collaboration is a key differentiator — GYN oncologists are involved in complex cases involving deep myometrial invasion or percreta with bladder/parametrial involvement
  • The program features a Level IV NICU, massive transfusion protocols, interventional radiology support, and dedicated OR nursing teams
  • Fertility preservation is evaluated on a case-by-case basis — Cleveland Clinic does not have a dedicated fertility-preserving PAS program, but conservative management may be offered to select patients
  • Member of the NICHD Maternal-Fetal Medicine Units (MFMU) Network, providing access to national research protocols and clinical trials

Program Overview

Cleveland Clinic manages placenta accreta spectrum through its Program for Advanced Surgical Obstetrics, which brings together maternal-fetal medicine specialists and gynecologic oncologists in a structured, team-based model. The program operates within one of the highest-ranked hospital systems in the United States, with access to extensive surgical, imaging, and critical-care resources that few institutions can match.

A distinguishing feature of the Cleveland Clinic PAS program is the integrated involvement of gynecologic oncology. GYN oncologists bring expertise in radical pelvic surgery, complex anatomy, and hemorrhage control — skills that are directly applicable to the most challenging PAS cases, particularly placenta percreta with bladder or parametrial invasion. This collaboration reflects growing evidence that GYN oncology involvement improves outcomes in complex PAS surgery.2

Cleveland Clinic is also a member of the NICHD Maternal-Fetal Medicine Units (MFMU) Network, one of the most important research consortia in obstetrics. MFMU membership indicates that the institution meets rigorous standards for research infrastructure and patient volume, and gives patients potential access to cutting-edge clinical trials.

The program's multi-site structure spans three hospitals in Northeast Ohio, with the most complex PAS cases managed at the Main Campus, which houses a Level IV NICU — the highest designation for neonatal care. A dedicated nurse coordinator serves as a central point of contact, helping patients navigate the numerous appointments, imaging studies, and specialist consultations that PAS management requires.

Fertility Preservation Status

⚠️ Fertility Preservation: Case-by-Case

Cleveland Clinic evaluates fertility preservation on a case-by-case basis but does not have a dedicated fertility-preserving PAS program. Patient materials indicate the surgical team "may be able to prevent hysterectomy" in select cases, but there is no published case series, named conservative management protocol, or documented outcomes data specific to uterine-sparing approaches at Cleveland Clinic.

Conservative management may be considered when clinical circumstances are favorable — for example, in cases of focal accreta without deep invasion or percreta. However, the program's primary strength lies in optimized cesarean hysterectomy supported by world-class surgical infrastructure and GYN oncology collaboration.

If uterine preservation is important to you, ask the care team directly about:

  • How many uterine-sparing procedures they have performed
  • What criteria they use to determine candidacy for conservative management
  • What the outcomes have been for patients who attempted uterine preservation
  • Whether a referral to a center with a dedicated conservative management program would be appropriate for your case
Management Strategy

Case-by-Case Conservative Management — Conservative management at Cleveland Clinic is described as “rare and individual.” The approach depends on the extent and depth of placental invasion:

  • Focal adherence: manual extraction or surgical excision of the involved area + repair
  • Larger defects: en bloc removal of the uteroplacental defect + uterine closure

There is no standardized conservative management protocol; each case is evaluated individually based on intraoperative findings and patient circumstances.

Key Physicians

Amanda Kalan, MD

Maternal-Fetal Medicine, Cleveland Clinic

Dr. Kalan is a maternal-fetal medicine specialist involved in the surgical management of placenta accreta spectrum at Cleveland Clinic. Her clinical focus includes high-risk obstetrics, abnormal placentation, and complex cesarean delivery planning. She works within the multidisciplinary PAS team to coordinate prenatal surveillance, delivery timing, and surgical approach for patients with PAS.

Oluwatosin Goje, MD

Maternal-Fetal Medicine, Cleveland Clinic

Dr. Goje is a maternal-fetal medicine specialist with expertise in complex placentation and high-risk obstetric care. She contributes to the PAS program's prenatal diagnostic evaluation, management planning, and perioperative care for patients with abnormally invasive placenta.

Gynecologic Oncology Team

Department of Gynecologic Oncology, Cleveland Clinic

Cleveland Clinic's gynecologic oncology team is involved in complex PAS cases, particularly those with deep myometrial invasion, percreta extending to the bladder or parametrium, or cases requiring radical surgical techniques. GYN oncologists bring expertise in pelvic anatomy, retroperitoneal dissection, and complex hysterectomy that is directly applicable to advanced PAS surgery.3

Multidisciplinary Team Composition

Cleveland Clinic assembles a comprehensive multidisciplinary team for each PAS case, leveraging the institution's depth of subspecialty expertise:

  • Maternal-Fetal Medicine (MFM) — prenatal diagnosis, ultrasound surveillance, delivery planning, and overall care coordination
  • Gynecologic Oncology — co-management of surgical approach for complex cases, radical hysterectomy technique, pelvic surgery expertise
  • Interventional Radiology — pre-operative balloon catheter placement, uterine artery embolization, and post-operative hemorrhage management
  • Urology — ureteral stent placement, cystoscopy, and bladder management when placental invasion extends beyond the uterus
  • Anesthesiology — specialized obstetric anesthesia team with expertise in arterial monitoring, massive transfusion coordination, and hemodynamic management
  • Neonatology — Level IV NICU at Main Campus providing the highest level of neonatal intensive care
  • Blood Bank / Transfusion Medicine — robust massive transfusion protocol, cell salvage capability, and blood bank resources to support high-volume transfusion needs
  • Dedicated OR Nursing Team — surgical nursing staff experienced in complex obstetric procedures
  • Nurse Coordinator — central point of contact for scheduling, care coordination, and patient navigation throughout the PAS journey
📌 Level IV NICU

Cleveland Clinic's Main Campus houses a Level IV NICU — the highest designation for neonatal intensive care. Level IV NICUs provide surgical repair of complex congenital conditions, ECMO, and the most advanced respiratory support. PAS deliveries often occur at 34–36 weeks gestation, and access to Level IV neonatal services provides maximum safety for preterm infants who may need specialized care.

📌 Blood Bank Strength

Cleveland Clinic's blood bank and transfusion medicine service is a major institutional strength for PAS care. The hospital maintains a large blood product inventory, established massive transfusion protocols, and cell salvage capability. Strong blood bank support is one of the most important factors in PAS surgical safety, as hemorrhage remains the leading cause of morbidity in PAS surgery.1

Published Outcomes

Cleveland Clinic's PAS-specific publication record is oriented more toward contributing to multi-center studies through the MFMU Network than publishing single-center case series. Key aspects of the program's outcomes profile include:

Planned Cesarean Hysterectomy

The program reports low complication rates for planned cesarean hysterectomy, supported by the strong interventional radiology and blood bank infrastructure that helps minimize transfusion requirements. The integration of gynecologic oncology in complex cases contributes to lower rates of surgical complications related to inadvertent injury to adjacent organs.

GYN Oncology Collaboration

Published data from multiple centers have demonstrated that gynecologic oncology involvement in PAS surgery is associated with reduced blood loss, fewer urologic injuries, and lower overall complication rates. Cleveland Clinic built this collaboration into the program's structure from its inception, reflecting an evidence-based approach to PAS surgical management.2

MFMU Network Research

As a member of the NICHD MFMU Network, Cleveland Clinic contributes patient data to large-scale obstetric clinical trials. The MFMU Network has produced many of the landmark studies that have shaped modern PAS management, and Cleveland Clinic's participation ensures that its patients have access to the latest evidence-based protocols.

Patients are encouraged to ask the care team about the program's case volume, complication rates, and specific outcomes during their consultation, as institutional data may be available even if not yet published in peer-reviewed journals.

Practical Information

Contact

  • Hospital: Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH 44195
  • Phone: 216-444-9706
  • Department: Department of Obstetrics & Gynecology, Program for Advanced Surgical Obstetrics
  • Website: my.clevelandclinic.org
  • Patient Portal: MyChart portal available for virtual visits, messaging, and appointment management

Multi-Site Locations

PAS care may be available at multiple Cleveland Clinic hospitals in Northeast Ohio:

  • Main Campus (Cleveland) — Level IV NICU; site for the most complex PAS surgeries and full multidisciplinary team access
  • Hillcrest Hospital (Mayfield Heights) — Level III NICU; high-volume delivery center
  • Fairview Hospital (Cleveland west side) — additional delivery capability

Complex PAS cases requiring the full multidisciplinary team are typically managed at the Main Campus. Discuss with your care team which site is appropriate for your specific case.

Insurance

Cleveland Clinic accepts most major insurance plans. The hospital has a large out-of-state patient population and experienced financial counselors who can help verify coverage and obtain prior authorizations for complex PAS care. Contact Cleveland Clinic's financial services early in the process to confirm benefits.

Telemedicine

Cleveland Clinic offers virtual visits through its MyChart portal, including scheduled video visits for initial consultations and follow-up appointments. Telemedicine is particularly valuable for patients traveling from outside Ohio who wish to establish care before relocating for delivery. In-person evaluation will be required for detailed imaging, surgical planning, and pre-operative assessment.

Travel

  • Airport: Cleveland Hopkins International Airport (CLE), approximately 25 minutes from Main Campus
  • Accommodations: Several hotels are located within walking distance of the Main Campus on Euclid Avenue, and Cleveland Clinic provides lodging assistance for out-of-state patients through its Guest Services department
  • Location: The Main Campus is situated in the University Circle area of Cleveland, with convenient access to public transportation and major highways

References

  1. ACOG/SMFM Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
  2. Silver RM, Fox KA, Barton JR, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015;212(5):561-568. PMID: 25460838
  3. Shamshirsaz AA, Fox KA, Erfani H, et al. Multidisciplinary team management and outcomes in patients with placenta accreta spectrum disorders. Am J Obstet Gynecol. 2018;218(2):S841. PMID: 29752934
  4. Cahill AG, Beigi R, Engstrom JL, et al. Placenta accreta spectrum. Am J Obstet Gynecol. 2018;219(6):B2-B16. PMID: 30344106
  5. Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220(6):511-526. PMID: 30849358
  6. Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet. 2018;140(3):291-298. PMID: 29405382