Key Takeaways
- Ranked #10 among US PAS centers, with strong surgical outcomes and innovative hemorrhage control techniques
- Pioneering the use of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) in PAS surgery — an endovascular balloon placed in the aorta to control pelvic bleeding, with published data showing reduced blood loss
- Unusual MDT composition includes trauma/vascular surgery as a core team member, bringing REBOA and damage-control expertise
- Michigan Medicine is one of the largest academic medical centers in the United States, with a Level IV NICU and high-volume obstetric experience
- Fertility preservation is not a focus — cesarean hysterectomy is the standard surgical approach; patients seeking uterine preservation should discuss options explicitly and may need referral
Program Overview
The University of Michigan's PAS program operates within Michigan Medicine, one of the largest and most comprehensive academic medical centers in the United States. Located in Ann Arbor, Michigan, the program leverages the institution's depth of surgical subspecialty expertise to manage placenta accreta spectrum disorders through a multidisciplinary approach.
What most distinguishes the Michigan program is its pioneering work with REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) — a technique adapted from trauma surgery in which a balloon catheter is placed in the aorta to temporarily reduce blood flow to the pelvis during the most hemorrhage-prone phases of PAS surgery. This innovation reflects the program's unique integration of vascular and trauma surgery expertise into the PAS team.
The program is primarily oriented toward surgical excellence, with cesarean hysterectomy as the standard approach for PAS. The integration of REBOA and advanced hemorrhage control techniques aims to make this already-complex surgery safer by reducing intraoperative blood loss and improving surgical field visibility.
Michigan Medicine's academic research mission also drives ongoing investigation into PAS outcomes, hemorrhage prevention, and the role of endovascular techniques in obstetric surgery.
Fertility Preservation Status
The University of Michigan PAS program is oriented toward planned cesarean hysterectomy as the standard surgical approach. There is no published evidence of a routine fertility-preservation program, named conservative management protocol, or patient-facing materials describing uterine-sparing options at this center.
If preserving your uterus and future fertility is a priority, you should raise this directly with the Michigan care team early in your consultation. Be aware that the program's infrastructure, surgical planning, and team composition are built around hysterectomy as the definitive treatment. You may need a referral to a center with published conservative management experience if uterine preservation is essential to your goals.
This does not reflect a deficiency in care — planned cesarean hysterectomy remains the standard of care recommended by ACOG for most PAS cases. However, patients for whom fertility is a top priority should ensure they are seen at a center that routinely offers and publishes on conservative approaches.
Key Physicians
Marjorie C. Treadwell, MD
Director of Perinatal Diagnosis, MFM Lead
Dr. Treadwell is the Director of Perinatal Diagnosis at the University of Michigan and the Maternal-Fetal Medicine lead for complex placentation cases, including PAS. She brings extensive experience in prenatal diagnosis, advanced obstetric imaging, and coordination of multidisciplinary care for high-risk pregnancies.
Cosmas Van De Ven, MD
Trauma & Vascular Surgery, REBOA Specialist
Dr. Van De Ven brings trauma and vascular surgery expertise to the PAS team, with particular focus on REBOA placement and hemorrhage control. His involvement reflects Michigan's innovative approach to integrating trauma surgery techniques into obstetric care for the most hemorrhage-prone PAS cases.
Gynecologic Oncology Surgical Support
Complex Pelvic Surgery
GYN oncology surgeons participate in complex PAS cases at Michigan, particularly those involving deep invasion into the parametrium or adjacent organs. Their training in radical pelvic surgery is valuable when PAS extends beyond the standard surgical planes.
Multidisciplinary Team Composition
The University of Michigan PAS team includes several specialties not commonly found on PAS teams at other centers, most notably trauma/vascular surgery:
- Maternal-Fetal Medicine (MFM) — prenatal diagnosis, monitoring, and delivery planning (Dr. Treadwell)
- Vascular / Trauma Surgery — REBOA placement, hemorrhage control, and damage-control surgery (Dr. Van De Ven)
- Gynecologic Oncology — complex pelvic dissection and surgical support for invasive cases
- Interventional Radiology — vascular catheter placement and embolization
- Urology — ureteral stenting, bladder management, and reconstruction when PAS invades the urinary tract
- Anesthesiology — high-risk obstetric anesthesia, arterial line management, massive transfusion coordination
- Blood Bank / Transfusion Medicine — massive transfusion protocol, cell salvage
- Neonatology — Level IV NICU capability, the highest neonatal care level
REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) involves threading a catheter with an inflatable balloon into the aorta, typically via the femoral artery. When inflated in zone 3 (the infrarenal aorta, below the kidneys but above the pelvic blood supply), it temporarily reduces blood flow to the pelvis. In PAS surgery, this provides two key advantages: reduced blood loss during the most critical phases of placental separation and hysterectomy, and improved surgical field visibility by decreasing active hemorrhage. The technique was originally developed for trauma patients with catastrophic pelvic bleeding and has been adapted by the Michigan team for use in PAS surgery.
Published Outcomes
REBOA for PAS: Zone 3 Placement
The University of Michigan's landmark contribution to PAS care is its research on REBOA for hemorrhage control during PAS surgery. A published study examining distal zone 3 REBOA placement demonstrated significant reduction in intraoperative blood loss:1
| Outcome | Result |
|---|---|
| Reduction in blood loss | REBOA-assisted cases showed reduced blood loss in published series |
| Mechanism | Zone 3 (infrarenal) aortic occlusion reduces pelvic blood flow |
| Benefit | Improved surgical field visibility and hemorrhage control |
REBOA represents a significant innovation in PAS hemorrhage management. By temporarily occluding the aorta below the renal arteries, the technique reduces blood flow specifically to the pelvis while preserving perfusion to the kidneys and abdominal organs. While not yet widely adopted across PAS centers, the Michigan data provide early evidence supporting this approach for one of the most hemorrhage-prone surgeries in obstetrics.
Venous Thromboembolism (VTE) Risk in PAS
Research from the Michigan group has identified that PAS patients face a substantially elevated risk of venous thromboembolism compared to the general obstetric population, with implications for perioperative prophylaxis protocols.2
Clinical Trials
As a major academic medical center, the University of Michigan maintains an active clinical research portfolio. Patients interested in PAS-related studies should:
- Ask their MFM provider about currently enrolling protocols, particularly studies involving REBOA and endovascular techniques
- Search ClinicalTrials.gov using terms "placenta accreta" and "University of Michigan"
- Inquire about hemorrhage prevention and VTE prophylaxis studies, given the program's active research in these areas
Practical Information
Contact
- Hospital: Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109
- Department: Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology
- Website: uofmhealth.org
Insurance
Michigan Medicine accepts most major insurance plans, including many Michigan-based and national plans. As an academic medical center, prior authorization may be required for specialized procedures. Contact Michigan Medicine's financial counseling office to verify coverage, especially for patients traveling from out of state.
Telemedicine
Michigan Medicine offers telehealth consultations through its patient portal. Initial PAS evaluations may be available via video visit for patients who live at a distance from Ann Arbor. In-person evaluation will be required for advanced imaging and surgical planning. Ask about telemedicine options when scheduling your appointment.
Travel Considerations
- Airport: Detroit Metropolitan Wayne County Airport (DTW), approximately 30 minutes from Ann Arbor
- Driving: Ann Arbor is accessible via I-94 and US-23, with extensive hotel and lodging options near the medical center
- Location note: Ann Arbor is a mid-sized college town with a wide range of accommodations, restaurants, and family-friendly amenities for patients relocating temporarily for PAS management
References
- Triebwasser JE, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) with distal zone 3 placement for hemorrhage control during cesarean hysterectomy for placenta accreta spectrum. Am J Obstet Gynecol. 2023. PMID: 36812423
- Stout MJ, et al. Venous thromboembolism risk in placenta accreta spectrum. Presented at ACOG Annual Meeting, 2025.
- ACOG/SMFM Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
- Silver RM, et al. Center of excellence for placenta accreta spectrum. Am J Obstet Gynecol. 2015;212(5):561-568. PMID: 25460838
- Morrison JJ, et al. Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. Shock. 2014;41(2):130-137. PMID: 24434414