{ "abstract": "This practical guidance was developed by the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation to support antenatal diagnosis and clinical management in pregnancies at risk for placenta accreta spectrum (PAS). It provides an evidence-informed approach to screening, diagnosis, referral, and peripartum planning across healthcare settings with different resources. PAS is increasingly encountered alongside rising cesarean delivery rates, use of in vitro fertilization, and a history of uterine surgery. It remains associated with severe maternal morbidity, including massive hemorrhage, large-volume transfusion, uterine rupture, peripartum hysterectomy, pelvic organ injury, intensive care admission, and maternal death. Early recognition and multidisciplinary care are therefore central to management. Cesarean scar pregnancy (CSP) is considered a potential precursor of PAS. Women with a low implantation site and a previous cesarean delivery are at increased risk. Early transvaginal ultrasound is advised in women with a previous cesarean delivery to establish the implantation site, identify CSP, and support counseling and timely consideration of uterine-preserving treatment. In the second and third trimesters, combined transabdominal and transvaginal ultrasound assesses placental location, myometrial thickness and contour, and the uterovesical interface. Sonographic markers include placental lacunae, placental bulge, uterovesical hypervascularity, and bridging vessels, which may occur individually or in combination. Two-dimensional grayscale ultrasound is the mainstay of antenatal assessment, supported by color Doppler; three-dimensional imaging may provide additional information in selected specialist settings. Magnetic resonance imaging has a complementary role when ultrasound is inconclusive, placental location is non-anterior or non-previa, or technical factors limit visualization. Suspected CSP or PAS should prompt referral to a perinatal center with multidisciplinary expertise, blood product support, adult and neonatal intensive care, and access to complex pelvic surgery. Delivery timing and surgical preparation should be individualized.", "abstract_shown": true, "affiliations": [ "Department of Maternal-Fetal Medicine University of Parma and University Hospital of Parma Parma Italy.", "Imperial College London London UK.", "Perinatal Medicine Foundation Istanbul Türkiye.", "Department of Perinatal Medicine Istanbul University-Cerrahpaşa Istanbul Türkiye.", "Faculty of Medicine Universitas Airlangga Dr. Soetomo General Academic Hospital Surabaya Indonesia.", "Erasmus Medical Center Rotterdam the Netherlands.", "Department of Metabolism, Digestion and Reproduction Imperial College London London UK.", "Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust London UK.", "Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand.", "Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine, and Texas Children's Pavilion for Women Houston Texas USA.", "University of Texas Medical Branch in Galveston Houston Texas USA.", "Department of Obstetrics and Gynecology, College of Medicine National Taiwan University, and National Taiwan University Hospital Taipei Taiwan.", "Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK.", "Department of Obstetrics and Gynecology Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello Palermo Italy.", "Center for Fetal Care and High-Risk Pregnancy, Department of Medicine and Aging Sciences G. d'Annunzio University of Chieti-Pescara Chieti Italy.", "Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science Icahn School of Medicine at Mount Sinai New York New York USA." ], "article_type": "research article", "arxiv": null, "author_total": 12, "authors": [ { "affs": [ 0, 1 ], "name": "Andrea Dall'Asta", "orcid": "0000-0001-7201-0206" }, { "affs": [ 2, 3 ], "name": "Cihat Sen", "orcid": "0000-0002-2822-6840" }, { "affs": [ 4, 5 ], "name": "Rozi Aryananda", "orcid": "0000-0001-6674-7682" }, { "affs": [ 6, 7 ], "name": "Christoph Lees" }, { "affs": [ 8 ], "name": "Savitree Pranpanus" }, { "affs": [ 9 ], "name": "Hennie Lombaard" }, { "affs": [ 10 ], "name": "Karin A Fox", "orcid": "0000-0002-8405-772X" }, { "affs": [ 11 ], "name": "Jin-Chung Shih", "orcid": "0000-0002-0296-4327" }, { "affs": [ 12 ], "name": "Theophilus Adu-Bredu" }, { "affs": [ 13 ], "name": "Giuseppe Calì" }, { "affs": [ 14 ], "name": "Francesco D'Antonio", "orcid": "0000-0002-7546-8025" }, { "affs": [ 15 ], "name": "Ilan Timor-Tritsch", "orcid": "0000-0001-9774-3107" } ], "bibtex": "https://research.draconitic.com/paper/8mt633a449ytd.bib", "cited_by": 0, "doi": "10.1002/pmf2.70489", "fulltext_url": "https://europepmc.org/articles/PMC13695033", "id": "8mt633a449ytd", "issns": [ "2997-9684" ], "landing_url": "https://europepmc.org/article/MED/42927239", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "QH301-705.5" ], [ "lcc", "RC31-1245" ], [ "lcc", "RG1-991" ], [ "openalex", "2735|Maternal and fetal healthcare" ] ], "openalex": "W7223456596", "pdf_url": "https://europepmc.org/articles/PMC13695033?pdf=render", "pmcid": "PMC13695033", "pmid": "42927239", "published": "2026-10-24", "publisher": "Wiley", "ris": "https://research.draconitic.com/paper/8mt633a449ytd.ris", "sources": [ { "first_seen": "2026-10-30T12:21:18Z", "native_id": "MED:42927239", "source": "europepmc", "url": "https://europepmc.org/article/MED/42927239" }, { "first_seen": "2026-10-30T13:44:39Z", "native_id": "6298ab30e5684e13883c7307dce73db7", "source": "doaj", "url": "https://doi.org/10.1002/pmf2.70489" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2735|Maternal and fetal healthcare", "subfield": "reproductive-child" } ], "title": "Antenatal diagnosis and classification for placenta accreta (adherence) spectrum: Clinical practice guideline and recommendations by the World Association of Perinatal Medicine and the Perinatal Medicine Foundation.", "title_text": "Antenatal diagnosis and classification for placenta accreta (adherence) spectrum: Clinical practice guideline and recommendations by the World Association of Perinatal Medicine and the Perinatal Medicine Foundation.", "type": "peer-reviewed", "updated_at": "2026-10-30T13:44:39Z", "url": "https://research.draconitic.com/paper/8mt633a449ytd", "venue": "Pregnancy (Hoboken, N.J.)", "versions": [] }