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.
16 affiliations
- 1Department of Maternal-Fetal Medicine University of Parma and University Hospital of Parma Parma Italy.
- 2Imperial College London London UK.
- 3Perinatal Medicine Foundation Istanbul Türkiye.
- 4Department of Perinatal Medicine Istanbul University-Cerrahpaşa Istanbul Türkiye.
- 5Faculty of Medicine Universitas Airlangga Dr. Soetomo General Academic Hospital Surabaya Indonesia.
- 6Erasmus Medical Center Rotterdam the Netherlands.
- 7Department of Metabolism, Digestion and Reproduction Imperial College London London UK.
- 8Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust London UK.
- 9Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand.
- 10Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine, and Texas Children's Pavilion for Women Houston Texas USA.
- 11University of Texas Medical Branch in Galveston Houston Texas USA.
- 12Department of Obstetrics and Gynecology, College of Medicine National Taiwan University, and National Taiwan University Hospital Taipei Taiwan.
- 13Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK.
- 14Department of Obstetrics and Gynecology Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello Palermo Italy.
- 15Center for Fetal Care and High-Risk Pregnancy, Department of Medicine and Aging Sciences G. d'Annunzio University of Chieti-Pescara Chieti Italy.
- 16Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science Icahn School of Medicine at Mount Sinai New York New York USA.
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.
Related
- Focused Update to International Consensus Recommendations for the Use of Prolonged‐Infusion Beta‐Lactam Antibiotics Among Severely Ill Adult Patients: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists
- Recommendations for microbiological sampling in infected hard-to-heal wounds: an Italian association for cutaneous ulcers (AIUC) perspective
- Association of Conception Mode with Antenatal Anxiety, Depression, and Delivery Outcomes: A Multicenter Cohort Study
- Recommendations for the Diagnosis and Treatment of Genitourinary Syndrome of Menopause from the Italian Society of Menopause (SIM) and Italian Society of Gynecology of the Third Age (SIGiTE).
- CERVEX: A Foundation-Model Framework With Built-In Explainable AI for Automated Cervical Cytology Classification From Pap Smear Images
BibTeX
@article{dallasta2026antenatal,
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.}},
author = {Andrea Dall'Asta and Cihat Sen and Rozi Aryananda and Christoph Lees and Savitree Pranpanus and Hennie Lombaard and Karin A Fox and Jin-Chung Shih and Theophilus Adu-Bredu and Giuseppe Calì and Francesco D'Antonio and Ilan Timor-Tritsch},
journal = {Pregnancy (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1002/pmf2.70489},
url = {https://europepmc.org/article/MED/42927239},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Andrea Dall'Asta
AU - Cihat Sen
AU - Rozi Aryananda
AU - Christoph Lees
AU - Savitree Pranpanus
AU - Hennie Lombaard
AU - Karin A Fox
AU - Jin-Chung Shih
AU - Theophilus Adu-Bredu
AU - Giuseppe Calì
AU - Francesco D'Antonio
AU - Ilan Timor-Tritsch
PY - 2026
DA - 2026/10/24
JO - Pregnancy (Hoboken, N.J.)
DO - 10.1002/pmf2.70489
UR - https://europepmc.org/article/MED/42927239
AB - 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.
SN - 2997-9684
ER -