Walker, Sarah P. and Bartels, Helena C. and Nieto-Calvache, Albaro J. and Palacios-Jaraquemada, José M. and Collins, Sally L. and Aryananda, Rozi (2026) Strategies for streamlining uterine topographic classification in placenta accreta spectrum. AJOG Global Reports, 6 (2).

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Abstract

Effective management of anterior placenta previa, uterine dehiscence, and placenta accreta spectrum (PAS) requires a comprehensive understanding of uterine topography and vascular anatomy, knowledge that typically develops with time and through experience. This article aims to present a simplified, practical framework to support clinicians in PAS referral centers managing only a few cases per year, offering practical strategies to overcome challenges frequently encountered during the incorporation of individualized, topography-based surgical management. Recognizing anatomical patterns, anticipating complications based on topographical type, and tailoring vascular control strategies to each case allows for more confident, uterine-sparing surgical approaches when appropriate, and timely transition to hysterectomy when required. While most cases will fall within the more manageable upper peritoneal reflection placenta accreta types, clinicians must be prepared for the occasional complex or rare presentation. Ongoing collaboration between institutions, humility in seeking support, and integration of telecompanionship can help ensure that these rare cases are handled with the benefit of collective expertise. © 2026 The Authors.

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