Key Takeaways
- The Utah Placenta Accreta Program treats approximately 44 PAS cases per year, with 40% of patients traveling from out of state
- Fertility preservation is a core strength — roughly 80% of patients who choose conservative management avoid hysterectomy
- Dr. Robert Silver has published over 400 peer-reviewed papers and co-authored the seminal NEJM PAS review
- This is the only US center with active federal (NICHD) funding specifically for conservative PAS management research
- Weekly PAS clinic every Wednesday with telehealth consultations available
Program Overview
The University of Utah Health Placenta Accreta Program in Salt Lake City is one of the most established and research-driven PAS programs in the United States. Founded on a strong tradition of placental research, the program has grown into a national referral center that draws patients from across the country.
With approximately 44 confirmed PAS cases per year and an additional volume of consultation patients (60–70 annually), the program has accumulated deep institutional experience. Roughly 40% of their patients travel from out of state, underscoring the program's national reputation — particularly for patients seeking alternatives to hysterectomy.
The program holds a Society for Obstetric Anesthesia and Perinatology (SOAP) Center of Excellence designation, recognizing its anesthesia protocols and multidisciplinary integration for high-risk obstetric surgery.
Fertility Preservation Status
The University of Utah is a national leader in fertility-preserving conservative PAS management. Their published data show that approximately 80% of patients who choose conservative management successfully avoid hysterectomy, with the placenta typically resolving over 2–5 months. This program is one of the very few in the United States with an active, federally funded study (NICHD K23 grant) dedicated specifically to conservative PAS treatment.1
Strategy B/C: Individualized Conservative Management — The Utah program primarily uses a leaving-placenta-in-situ approach (Strategy B) with individualized elements (Strategy C). Dr. Einerson describes approaches including “letting the placenta go away or resorb, or removing the affected part.” The strategy is tailored to each patient based on depth of invasion, clinical factors, and reproductive goals.6
The program sees approximately 60–70 PAS consults per year, making it one of the highest-volume US referral centers for PAS evaluation. Of these, approximately 44 are confirmed PAS cases requiring delivery planning. Dr. Einerson holds an NICHD K23 career development award (K23HD106009) specifically studying conservative management — the only federally funded study of its kind in the United States.
Conservative management at Utah involves leaving the placenta in situ after cesarean delivery, with close follow-up including serial imaging and laboratory monitoring. Their approach is individualized based on the depth of invasion, patient preferences, and clinical factors. Patients considering this option should discuss candidacy, expected timeline, and the approximately 20% rate of delayed hysterectomy with the care team.
Patients who successfully preserve their uterus after PAS should be counseled that there is a 30–50% risk of PAS recurrence in subsequent pregnancies. This recurrence risk is a critical factor in reproductive planning decisions and should be discussed thoroughly with the care team before pursuing conservative management.
Key Physicians
Brett D. Einerson, MD, MPH
Director, Utah Placenta Accreta Program
Dr. Einerson leads the clinical PAS program and holds an NIH/NICHD K23 career development award studying alternative treatments for PAS. He is a board member of the Pan-American Society for Placenta Accreta Spectrum (PAS²) and has published extensively on conservative PAS management outcomes.
Robert M. Silver, MD
Chair, Department of Obstetrics & Gynecology
Dr. Silver is one of the most prolific PAS researchers in the world, with over 400 peer-reviewed publications. He co-authored the landmark New England Journal of Medicine review on placenta accreta spectrum (2018) and contributed to the ACOG/SMFM Obstetric Care Consensus on PAS. His decades of research have shaped the field's understanding of PAS epidemiology, diagnosis, and management.2
D. Ware Branch, MD
Maternal-Fetal Medicine
Dr. Branch is a senior MFM specialist with extensive experience in high-risk obstetrics, antiphospholipid syndrome, and PAS. He has been a key contributor to the program's growth and its reputation in complex placental disorders.
Christine Warrick, MD
Obstetric Anesthesiology
Dr. Warrick leads the obstetric anesthesia component of the PAS team. The program's SOAP Center of Excellence designation reflects the anesthesia team's specialized protocols for managing the unique challenges of PAS surgery, including massive transfusion readiness and hemodynamic monitoring.
Multidisciplinary Team Composition
The Utah PAS program assembles a comprehensive multidisciplinary team (MDT) for every case, including:
- Maternal-Fetal Medicine (MFM) — primary surgical and clinical management
- Obstetric Anesthesiology — SOAP Center of Excellence team
- Gynecologic Oncology — available for complex surgical cases
- Interventional Radiology — for uterine artery embolization when indicated
- Urology — for bladder involvement cases
- Neonatology — Level IV NICU support
- Blood Bank / Transfusion Medicine — massive transfusion protocol and cell salvage
- Social Work and Mental Health — patient and family support
Weekly Wednesday PAS clinics ensure coordinated planning, and all team members participate in pre-surgical case conferences for each patient.
Published Outcomes
The Utah program has contributed significantly to the evidence base for conservative PAS management. Key published outcomes include:
Conservative Management Success
Approximately 80% of patients who choose conservative management avoid hysterectomy. The placenta typically resorbs over a period of 2–5 months, during which patients are monitored with serial imaging and laboratory testing.1
Meta-Analysis: Conservative vs. Hysterectomy (AJOG 2025)
A 2025 meta-analysis published in the American Journal of Obstetrics and Gynecology, co-authored by Utah investigators, demonstrated that conservative management was associated with 974 mL less blood loss compared to cesarean hysterectomy, along with reduced transfusion requirements and fewer surgical complications.3
Research Portfolio
The program's research spans PAS epidemiology, imaging, surgical technique, and long-term outcomes. Dr. Silver's body of work includes contributions to every major PAS guideline in the English-speaking world.
Clinical Trials
The University of Utah is the site of the only federally funded (NICHD) study in the United States specifically investigating conservative PAS management. Dr. Einerson's K23-funded research program is focused on:
- Identifying which patients are optimal candidates for conservative management
- Developing evidence-based protocols for placenta-in-situ follow-up
- Characterizing long-term outcomes including subsequent pregnancy success
Patients interested in participating in research should ask about eligibility during their consultation. The program actively collaborates with other PAS research centers nationally and internationally.
Practical Information
Contact
- Phone: 801-213-2995
- PAS Clinic: Every Wednesday morning
- Website: healthcare.utah.edu — Placenta Accreta Clinic
Telemedicine
Virtual consultations are available, particularly for patients in the Mountain West region. Out-of-state patients can initiate care with a telehealth visit before traveling to Salt Lake City for in-person evaluation and delivery planning.
Insurance
As a major academic medical center, University of Utah Health accepts most major insurance plans. Because 40% of patients come from out of state, the program has experience helping patients navigate out-of-network authorization and travel logistics. Contact the clinic to verify your specific coverage before scheduling.
Travel Considerations
Salt Lake City is served by Salt Lake City International Airport (SLC) with direct flights from most major US cities. The University of Utah Hospital is approximately 15 minutes from the airport. The program's patient coordinators can assist with lodging and logistics for out-of-state patients who need to relocate for the final weeks of pregnancy.
Designations
- SOAP Center of Excellence for Obstetric Anesthesia
- Level IV Maternal Care Center
- Level IV NICU
References
- Einerson BD, et al. Placenta accreta spectrum disorder: diagnosis, management, and the role of conservative treatment. Am J Obstet Gynecol. 2023. PMID: 36933626
- Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018;378(16):1529-1536. PMID: 29669225. doi:10.1056/NEJMcp1709324
- Shainker SA, et al. Conservative management versus cesarean hysterectomy for placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025. PMID: 39217925
- ACOG/SMFM Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
- Society for Obstetric Anesthesia and Perinatology (SOAP). Center of Excellence Program. soap.org/center-of-excellence
- Einerson BD. Editorial on conservative management of placenta accreta spectrum. 2023. PMID: 36717353