Evaluation of the topographic classification of placenta accreta spectrum: protocol for an ongoing prospective multicenter study
Abstract
BACKGROUND: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with increasing cesarean delivery rates worldwide. Existing classifications, such as the World Health Organization International Statistical Classification of Diseases and Health-Related Problems and the International Federation of Gynecology and Obstetrics system, describe depth of invasion and histopathological features but do not adequately predict surgical outcomes or guide individualized management. The PAS topographic classification describes the anatomical extent of uterine wall remodeling and the presence of uterovesical adhesions, allowing surgical teams to anticipate intraoperative complexity, organ involvement, and appropriate therapeutic strategies. Although successfully applied in selected centers, its broader evaluation across diverse healthcare settings is lacking. METHODS: We designed a prospective, multicenter, international cohort study enrolling patients with a high prenatal suspicion of PAS. Eligible patients are aged ≥ 18 years, undergoing surgery after 20 weeks’ gestation, and managed by multidisciplinary PAS teams familiar with the topographic classification. Standardized prenatal ultrasound staging and intraoperative surgical staging are required, with photographic and video documentation. Surgical strategies include one-step conservative surgery, total hysterectomy, and modified subtotal hysterectomy, guided by intraoperative classification. The primary…
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