International survey of practices used in the diagnosis and management of placenta accreta spectrum disorders

Objective: To identify geographic differences in diagnostic and treatment practices during the perinatal management of placenta accreta spectrum (PAS) disorders. Methods: An online survey was conducted from May 1 to August 1, 2017. The 18-item questionnaire was emailed to all members of the expert panel for the 2018 International Federation of Gynecology and Obstetrics consensus guidelines on PAS (n=34), as well as international experts who had contributed to the content of these guidelines (n=16). Results: Questionnaires were returned by 36 of the 50 experts (72% response rate). Most respondents were from Europe (n=22; 61%) or Asia (n=9; 25%). Despite large disparity in the number of patients with PAS disorders managed surgically or conservatively (range from 0 to >1000) and the different techniques used by the respondents, the screening and diagnostic methods used were similar, with transvaginal imaging used by 31 (86%) experts, and both ultrasonography and magnetic resonance imaging used by 22 (61%). In all, 22 (61%) experts indicated a preference for radical surgery, with primary cesarean hysterectomy leaving the placenta in situ reported as the most frequent approach (n=20; 55%). Conclusion: Wide variation found in global PAS practices indicated a need for standardized data and an evidence-based approach to the diagnosis and management of PAS disorders.