Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care

The incidence of placenta accreta spectrum (PAS), the deeply adherent placenta with associated increased risk of maternal morbidity and mortality, has seen a significant rise in recent years. As a result, there has been a rise in clinical and research focus on this complex diagnosis. There is international consensus that a multidisciplinary coordinated approach optimizes outomes. The composition of the team will vary from center to center, however, central themes of complex surgical expertise, specialists in prenatal diagnosis, critical care specialist, neonatology, obstetrics anesthesiologist, blood bank specialists, and dedicated mental health experts are universal throughout. Regionalization of care is a growing trend for complex medical needs but location of care alone is just a starting point. The goal of this paper is to provide an evidence-based framework for the critical infrastructure needed in addressing the unique antepartum, delivery, and postpartum needs of the PAS patient. Rather than a clinical checklist, we describe the personnel, clinical unit characteristics, and breadth of contributing clinical roles that make up a team. Screening protocols, diagnostic imaging, surgical and potential need for critical care, as well as trauma informed interaction are the basis for comprehensive care. The vision from the author group is that this publication provides a semblance of infrastructure standardization as a means to ensure proper preparation and readiness.