A multidisciplinary checklist for management of suspected placenta accreta

Rates of abnormally invasive placentation have been escalating. The condition requires meticulous planning to ensure safety at delivery. Although placenta accreta remains the most common reason for Caesarean hysterectomy in developed nations, medical and surgical therapies have allowed fertility preservation. Most planning strategies start with risk factor assessment and diagnostic imaging. Early planning of arrangements for antepartum and intrapartum management is preferable to late planning, when emergency situations are more likely to occur. Based on maternal and fetal morbidities, and published evidence of factors that may diminish these risks, we have developed a checklist to aid the antepartum and intrapartum management of potentially challenging cases of invasive placentation or to aid in considering tertiary care consultation and transfer. The proposed checklist may best benefit physicians working in primary and secondary levels of care in Canada. Ideally, this checklist would be available in electronic form, with alerts as needed; a copy of the checklist should be kept in the patient's medical chart, with periodic updates.