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UCSF Health — MAPS Program

The Multidisciplinary Approach to Placenta Accreta Spectrum — a standardized protocol with published before-and-after outcomes data

Last reviewed: March 2026

Key Takeaways

  • UCSF's MAPS protocol has been in place since January 2018, providing a standardized, reproducible approach to PAS surgical management
  • After MAPS implementation, intraoperative complication rates dropped dramatically — from 39% to 3%
  • The program is co-directed by a gynecologic oncologist and an MFM specialist, combining surgical expertise with high-risk obstetric care
  • UCSF is a member of the UC Fetal Consortium, a collaboration across five University of California medical centers
  • Fertility preservation is not a focus of the MAPS protocol — the standardized approach centers on planned cesarean hysterectomy

Program Overview

UCSF Health developed the MAPS (Multidisciplinary Approach to Placenta Accreta Spectrum) protocol and implemented it in January 2018. The program represents one of the more rigorously studied PAS protocols in the United States, with published before-and-after data demonstrating significant improvements in complication rates.

The MAPS protocol standardizes every phase of PAS management, from prenatal diagnosis through surgical delivery. Key protocol elements include routine ureteral stent placement, planned uterine artery embolization (UAE), and coordinated involvement of multiple surgical specialties. Nurse coordinators from multiple service lines help ensure that the complex logistics of PAS care are managed smoothly.

UCSF is also a member of the UC Fetal Consortium, a collaboration among five University of California medical centers (UCSF, UCLA, UC Davis, UC San Diego, and UC Irvine) that facilitates data sharing, protocol development, and research across a large population base.

Fertility Preservation Status

🚨 Fertility Preservation: Not a Focus

The MAPS protocol is built around planned cesarean hysterectomy as the standard surgical approach. The program's published "Roadmap to Safety" study included only patients who underwent hysterectomy — conservative (uterine-sparing) management was not part of the study protocol.1

This means that if preserving your uterus for future fertility is a priority, the UCSF MAPS program may not be the best fit. You should discuss this directly with the care team to understand whether any uterine-sparing approaches have been attempted outside the published protocol, but be aware that the program's published data and standardized pathway are oriented toward hysterectomy.

Key Physicians

Dr. Jocelyn Chapman, MD

  • Role: Co-Director, MAPS Program
  • Specialty: Gynecologic Oncology
  • Affiliation: UCSF Health, UCSF School of Medicine
  • Focus: Complex pelvic surgery, hemorrhage control, PAS surgical management

Dr. Arianna Cassidy, MD

  • Role: Co-Director, MAPS Program
  • Specialty: Maternal-Fetal Medicine
  • Affiliation: UCSF Health, UCSF School of Medicine
  • Focus: Prenatal PAS diagnosis, care coordination, protocol development, UC Fetal Consortium

Multidisciplinary Team Composition

The MAPS protocol brings together a standardized team for every PAS case:

  • Maternal-Fetal Medicine (MFM) — prenatal monitoring, diagnosis, delivery timing
  • Gynecologic Oncology — surgical co-leadership, complex hysterectomy
  • Interventional Radiology — uterine artery embolization (UAE) as part of the standardized protocol
  • Urology — ureteral stent placement (routine in the MAPS protocol) and cystoscopy
  • Anesthesiology — obstetric anesthesia, arterial line placement, massive transfusion management
  • Neonatology — NICU team present at delivery
  • Blood bank / transfusion medicine — pre-surgical cross-matching, massive transfusion protocol
  • Nurse coordinators — drawn from multiple service lines to coordinate the complex logistics of PAS care
📌 Standardized Protocol Elements

Unlike some PAS programs where the surgical approach varies by case, the MAPS protocol standardizes several key steps: routine ureteral stent placement (to protect the ureters during surgery) and planned uterine artery embolization (to reduce blood loss). This standardization is part of what makes the MAPS outcomes reproducible and measurable.

Published Outcomes

Roadmap to Safety: Before and After MAPS

The MAPS program's landmark publication compared PAS outcomes before and after protocol implementation in January 2018. The results were striking:1

Outcome Before MAPS After MAPS
Intraoperative complication rate 39% 3%

This dramatic reduction — from 39% to 3% — demonstrates the power of a standardized, multidisciplinary protocol. It also provides one of the few published before-and-after comparisons in PAS care, making it a valuable reference point for other programs developing their own protocols.

It is important to note that the study population included only patients who underwent cesarean hysterectomy. Patients managed conservatively (without hysterectomy) were not part of this dataset.

UC Fetal Consortium

As a member of the UC Fetal Consortium, UCSF participates in multi-center data collection and research across five UC medical centers. This consortium provides a larger dataset for studying PAS outcomes and enables collaborative quality improvement across institutions.

Clinical Trials

UCSF is an active research institution with ongoing studies in high-risk obstetrics. Patients interested in PAS-related clinical trials should:

  • Ask their MAPS team provider about currently enrolling protocols
  • Search ClinicalTrials.gov using "placenta accreta" and "UCSF"
  • Inquire about UC Fetal Consortium studies that may involve multi-center data collection

Practical Information

Contact

  • Hospital: UCSF Medical Center, 505 Parnassus Avenue, San Francisco, CA 94143
  • Department: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences
  • Phone: 415-353-2566 (OB/GYN appointments)
  • Website: ucsfhealth.org

Insurance

UCSF Health accepts most major insurance plans, including many PPO and HMO plans. As a University of California facility, Medi-Cal is also accepted. Contact UCSF's financial counseling services to verify coverage, particularly for out-of-state patients. High-risk pregnancy care at UCSF may require prior authorization from your insurer.

Telemedicine

UCSF offers video visits through its MyChart patient portal. Initial PAS consultations may be available via telemedicine, which can be particularly valuable for patients elsewhere in California or out of state who want to discuss whether the MAPS program is the right fit before traveling to San Francisco.

References

  1. Chapman J, Cassidy A, et al. Roadmap to Safety: A Multidisciplinary Approach to Placenta Accreta Spectrum. 2024. PMID: 38511075. PMC: PMC10950927
  2. ACOG/SMFM Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
  3. Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018;378(16):1529-1536. PMID: 29669225