Placenta Accreta Spectrum (PAS): Diagnosis and Management

▪️Standardized Ultrasound Definitions and Reporting for Placenta Accreta Spectrum

QS.1

Ultrasound assessments for suspected placenta accreta spectrum are performed using standardized diagnostic definitions and reported using a uniform, structured template to ensure consistent interpretation, communication, and clinical decision-making.

QM.1

Numerator: Number of ultrasound reports for suspected PAS that use standardized definitions and a uniform structured reporting template.

Denominator: Total number of ultrasound assessments performed for suspected PAS.

Measure: Evidence that a standardized reporting template and agreed diagnostic definitions for PAS are available and in active use within the imaging service.

Target: 100%.

▪️  Documentation of Informed Delivery Planning Discussions

QS.2

All women with suspected placenta accreta spectrum have a documented delivery plan that includes discussion with the woman and her partner about the risks and indications of blood transfusion and hysterectomy, and addresses any concerns.

QM.2

Numerator: Number of women with suspected PAS who have a documented delivery plan that includes discussion of blood transfusion, hysterectomy, and records any expressed concerns.

Denominator: Total number of women with suspected PAS.

Target: 100%.

▪️  Consultant-Led Obstetric Care

QS.3

A consultant obstetrician plans and directly supervises the elective birth of women with placenta accreta spectrum.

QM.3

Numerator: Number of women with PAS whose elective birth was planned and directly supervised by a consultant obstetrician.

Denominator: Total number of women with PAS undergoing elective birth.

Target: 100%.

▪️ Consultant-Led Anaesthetic Care

QS.4

A consultant anaesthetist plans and directly supervises the anaesthesia for elective delivery in women with placenta accreta spectrum.

QM.4

Numerator: Number of women with PAS whose anaesthesia was planned and directly supervised by a consultant anaesthetist during elective delivery.

Denominator: Total number of women with PAS undergoing elective delivery.

Target: 100%.

▪️ Availability of Blood and Blood Products

QS.5

 Blood and blood products are available on-site before elective surgery in women with placenta accreta spectrum.

QM.5

Evidence of availability of cross-matched blood and blood products for women with PAS prior to elective delivery.

Target: 100%.

▪️  Comprehensive Informed Consent

QS.6

 Informed consent for elective surgery in women with PAS includes discussion of possible interventions

QM.6

Numerator: Number of women with PAS whose documented consent includes discussion of hysterectomy, leaving the placenta in situ, blood transfusion, bladder injury, interventional radiology.

Denominator: Total number of women with PAS undergoing elective surgery.

Target: 100%.