Key Takeaways
- Published the largest US case series on uterine preservation: 180 patients (2015–2024)
- Of 29 patients planned for uterine preservation, 13 (45%) were successful
- Five patients subsequently had healthy pregnancies without PAS recurrence
- Described as “the only study of its kind evaluating uterine preservation for PAS in the United States”
- Medical Director: Dr. Farah Amro, MD
Program Overview
The UTHealth Houston Placenta Accreta Program in Houston, Texas, is a high-volume center with extensive experience managing placenta accreta spectrum disorders. Part of the UT Physicians system and McGovern Medical School at UTHealth Houston, the program has treated approximately 18 PAS cases per year over the past decade, accumulating one of the largest institutional cohorts in the country.
With a total of 180 confirmed PAS patients between 2015 and 2024, the program has generated the largest published US case series specifically evaluating uterine preservation outcomes for PAS — providing critical data on an approach that remains uncommon in the United States.
Fertility Preservation Status
Published outcomes from Amro et al., Obstetrics & Gynecology, June 2025: Of 180 PAS patients treated over a decade, 29 chose uterine preservation via a placenta-in-situ approach. Of those 29, 13 (45%) were successful in retaining their uterus. Five patients who underwent successful preservation subsequently had healthy pregnancies without PAS recurrence. The authors described their study as “the only study of its kind evaluating uterine preservation for PAS in the United States.”1
Strategy B: Non-surgical Conservative (Leaving Placenta In Situ) — After cesarean delivery, the cord is tied and the placenta is left in place to resorb naturally. Patients are monitored with serial imaging and labs. Median time to placental resorption was 17 weeks among successful cases.1
Management Breakdown: 180-Patient Cohort (2015–2024)
The following table details how the 180 confirmed PAS patients at UTHealth Houston were managed:1
| Management Pathway | n | % | Details |
|---|---|---|---|
| Immediate cesarean hysterectomy | ~130 | 72% | Standard of care for most patients |
| Placenta left in situ (total) | 43 | 24% | Includes both preservation and planned delayed hysterectomy groups |
| — Planned uterine preservation | 29 | — | Goal: retain uterus for future fertility |
| — Successful preservation | 13 | 45% | Uterus retained; median resorption 17 weeks |
| — Required interval hysterectomy | 16 | 55% | Uterine preservation unsuccessful |
| — Planned delayed hysterectomy | 14 | — | Placenta left in situ to reduce surgical complexity |
| Other / unclassified | ~7 | 4% | — |
Patient Selection Criteria
UTHealth Houston uses specific selection criteria for candidates for the leaving-placenta-in-situ approach. Key requirements include:
- Proximity to hospital: patient must live within approximately 1 hour of the medical center for emergency access
- Reliable follow-up: ability to attend frequent monitoring appointments (serial imaging and labs)
- Insurance coverage: adequate insurance to cover the extended monitoring period
- Strong support system: family or caregiver support during the weeks-to-months resorption period
The approach at UTHealth Houston involves leaving the placenta in situ after cesarean delivery, allowing for gradual resorption under close surveillance. Patients who underwent successful uterine preservation had a median estimated blood loss of 700 mL, compared to 1,950 mL for those in whom preservation was ultimately unsuccessful and hysterectomy was required. This significant difference highlights the importance of careful patient selection and the potential benefits when the approach succeeds.
Key Physicians
Farah Amro, MD
Medical Director, Placenta Accreta Program
Dr. Amro is the Medical Director of the UTHealth Houston Placenta Accreta Program and lead author of the landmark 180-patient uterine preservation study published in Obstetrics & Gynecology (2025). She is a maternal-fetal medicine specialist with deep expertise in conservative PAS management and the placenta-in-situ approach.1
Beth Pineles, MD, PhD
Formerly UTHealth Houston — Now at Penn Medicine
Dr. Pineles published an earlier 11-patient case series on uterine preservation (55% preservation rate) based on her work at UTHealth Houston.2 She also authored a key paper examining whether conservative PAS management is practical in the US setting.3 Dr. Pineles has since moved to Penn Medicine, where she established the PAS Center of Excellence.
Multidisciplinary Team Composition
The UTHealth Houston PAS program assembles a standard multidisciplinary team (MDT) for every case, including:
- Maternal-Fetal Medicine (MFM) — primary surgical and clinical management
- Gynecologic Oncology — available for complex surgical cases
- Obstetric Anesthesiology — specialized anesthesia protocols for PAS surgery
- Interventional Radiology — for uterine artery embolization when indicated
- Urology — for bladder involvement cases
- Neonatology — NICU support for preterm deliveries
- Blood Bank / Transfusion Medicine — massive transfusion protocol readiness
- Social Work and Mental Health — patient and family support
Published Outcomes
The UTHealth Houston program has contributed important data on uterine preservation for PAS, including the largest published US case series on this topic.
Amro et al. — 180-Patient Case Series (Obstetrics & Gynecology, 2025)
The landmark study by Amro et al. reviewed 180 patients with confirmed PAS managed at UTHealth Houston between 2015 and 2024. Of these, 29 patients elected uterine preservation using a placenta-in-situ approach. Key findings:1
- 13 of 29 (45%) patients achieved successful uterine preservation
- Successful preservation group: median estimated blood loss of 700 mL
- Unsuccessful preservation group (required delayed hysterectomy): median estimated blood loss of 1,950 mL
- Five patients who retained their uterus subsequently had healthy pregnancies without PAS recurrence
- The authors described this as “the only study of its kind evaluating uterine preservation for PAS in the United States”
Pineles et al. — 11-Patient Case Series (Am J Perinatol, 2024)
An earlier study by Pineles et al. reported on 11 patients who underwent attempted uterine preservation at UTHealth Houston, with a 55% success rate (6 of 11 patients avoided hysterectomy).2 This study helped lay the groundwork for the larger Amro et al. series and demonstrated the feasibility of conservative management in a US academic center.
Conservative Management Feasibility in the US (AJOG MFM, 2023)
Pineles et al. also published an important analysis examining whether conservative PAS management is practical in the United States, addressing systemic challenges including surgeon training, institutional infrastructure, and follow-up logistics.3
Practical Information
Contact
- Program: UT Physicians — Placenta Accreta Program
- Website: utphysicians.com/placenta-accreta-program/
References
- Amro F, et al. Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder. Obstet Gynecol. 2025;145(6). PMID: 40273455
- Pineles BL, et al. Uterine preservation in placenta accreta spectrum: a case series. Am J Perinatol. 2024.
- Pineles BL, et al. Is conservative management of placenta accreta spectrum practical in the United States? AJOG MFM. 2023. PMID: 36113717