Geographical variation in management of patients with placenta accreta spectrum: An international survey of experts (GPASS).

OBJECTIVE While evidence-based guidelines exist for placenta accreta spectrum (PAS) diagnosis and management, there is a paucity of data on PAS practice patterns worldwide. The objective of this study was to describe global geographic variations in the diagnosis and management of PAS. METHODS An international cross-sectional study was conducted among PAS experts practicing at medical institutions in member states of the United Nations. Survey questions focused on diagnostic evaluation and management strategies for PAS. RESULTS A total of 136 centers participated. Participating centers represented each of the United Nations' designated regions. Of those, 88% reported practicing in a medium or high volume center. First trimester PAS screen was reported in 26.1% of centers. Respondents consistently implement guideline-supported care practices, including utilization of ultrasound as the primary diagnostic modality (100%) and implementation of multidisciplinary care teams (85.8%). Less than 10% of respondents reported routinely managing PAS without hysterectomy; these centers were predominantly located in Europe and Africa. Antepartum management and availability of mental health support for PAS patients varied widely. CONCLUSION Worldwide, there is a strong adherence to PAS care guidelines; however, regional variations do exist. Comparing variations in care to outcomes will provide insight into the clinically significant practice variability.