Duke University Medical Center — PAS Program

Program Overview

Duke University Medical Center in Durham, North Carolina operates one of the top-ranked PAS programs in the United States, consistently recognized among the nation's leading centers for the surgical management of placenta accreta spectrum disorders. The program is anchored within Duke's Division of Maternal-Fetal Medicine and benefits from the broader resources of a world-class academic medical center.

Duke's approach to PAS emphasizes surgical excellence and morbidity reduction. The program's defining contribution to the field is the use of prophylactic uterine artery embolization (P-UAE) performed by interventional radiology immediately prior to or during cesarean hysterectomy. This strategy devascularizes the placental bed, substantially reducing intraoperative hemorrhage and transfusion requirements.1

In select cases, Duke has also employed a delayed hysterectomy approach, in which the initial cesarean delivery is performed with placenta left in situ, followed by embolization and interval hysterectomy once the uterine blood supply has diminished. This two-stage strategy can convert a high-risk emergency procedure into a more controlled, elective operation.

Duke actively participates in multicenter PAS registries, contributing institutional data to collaborative efforts aimed at standardizing PAS management and improving national outcomes.

Fertility Preservation Status

Key Physicians

Multidisciplinary Team Composition

Duke assembles a comprehensive multidisciplinary team (MDT) for every PAS case, reflecting the complexity of these surgeries and the institution's commitment to coordinated care:

• Maternal-Fetal Medicine (MFM) — primary clinical and surgical leads (Drs. Grotegut, Dotters-Katz)
• Gynecologic Oncology — complex pelvic and radical surgical expertise for cases with deep invasion
• Interventional Radiology — prophylactic uterine artery embolization (P-UAE)
• Vascular Surgery — available for cases involving major vascular structures
• Urology — for bladder, ureteral, or other urinary tract involvement
• Anesthesiology — high-risk obstetric anesthesia team with massive transfusion readiness
• Blood Bank / Transfusion Medicine — massive transfusion protocol, cell salvage capability
• Neonatology — Level IV NICU for premature and critically ill neonates

Pre-surgical case conferences bring all team members together to review imaging, plan the surgical approach, anticipate complications, and coordinate timing of delivery, embolization, and hysterectomy.

Published Outcomes

P-UAE and Reduced Blood Loss

Duke's key published contribution to PAS management is the demonstration that prophylactic uterine artery embolization (P-UAE) performed before cesarean hysterectomy significantly reduces intraoperative hemorrhage. In their published series, the P-UAE protocol reduced median estimated blood loss to approximately 1,000 mL, which compares favorably to the 2,000–5,000 mL blood loss commonly reported in PAS hysterectomy series without embolization.1

The reduction in blood loss translates to fewer transfusions, shorter ICU stays, and reduced overall surgical morbidity. This protocol does not avoid hysterectomy, but it makes the procedure substantially safer for the patient.

Delayed Hysterectomy Approach

In selected cases, Duke has employed a delayed (interval) hysterectomy strategy in which the cesarean delivery is performed first, the placenta is left in situ, and P-UAE is performed to devascularize the uterus. The hysterectomy is then carried out days to weeks later in a more controlled, elective setting. This approach can be particularly valuable for patients with extensive placenta percreta or when immediate hysterectomy would carry prohibitive hemorrhage risk.3

Multicenter Registry Participation

Duke contributes data to multicenter PAS registries, supporting collaborative research efforts to standardize outcome reporting and develop evidence-based management guidelines across institutions.

Clinical Trials

As a major academic medical center, Duke participates in multicenter PAS research collaborations. Specific areas of ongoing investigation include:

• Multicenter PAS registries — contributing institutional outcome data for collaborative analysis
• Optimizing embolization protocols — refining timing, technique, and patient selection for P-UAE
• PAS imaging and diagnosis — improving prenatal detection accuracy

Patients interested in research participation should ask about eligibility during their clinical consultation or contact the Duke PAS program directly.

Practical Information

Contact

• Hospital: Duke University Hospital, Durham, NC 27710
• Department: Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology
• Website: Duke Health — High-Risk Obstetrics

Insurance

Duke University Health System accepts most major insurance plans. Patients traveling from outside North Carolina should contact Duke Patient Revenue Management to verify coverage, obtain pre-authorization, and discuss any out-of-network considerations before scheduling.

Telemedicine

Duke offers telehealth services across many specialties. Contact the high-risk obstetrics clinic to inquire about virtual consultation availability for initial evaluation and second opinions before traveling to Durham.

Travel Considerations

Duke University Hospital is located in Durham, North Carolina, in the heart of the Research Triangle region. The hospital is approximately 20 minutes from Raleigh-Durham International Airport (RDU), which offers direct flights from most major US cities. The Research Triangle area provides extensive lodging, dining, and accommodation options near the medical center. Patient coordinators can assist with logistics for patients who need to relocate for the final weeks of pregnancy.

Designations

• Level IV NICU
• Top-ranked academic medical center (U.S. News & World Report)
• Active participant in multicenter PAS research registries

References