Towards precision medicine in placenta accreta spectrum: results from a survey-based evaluation of interactive...

Placenta accreta spectrum (PAS) has emerged as a pressing global health concern as cesarean delivery rates continue to rise. Once regarded primarily as a placental disorder, PAS is now understood as an abnormal implantation process occurring within uterine scars. Although cesarean hysterectomy remains the predominant management strategy, growing evidence suggests that individualized, uterine-sparing approaches may reduce morbidity and better align with patient preferences. Traditional histopathologic classifications neither correlate with prenatal imaging findings nor reflect surgical complexity, thereby limiting their clinical utility. The PAS topographic classification, developed from intraoperative observations, offers a practical framework for surgical staging and guides patient-specific management strategies. Standardized prenatal ultrasound can anticipate surgical challenges and facilitate preoperative counseling. Despite this, few hospitals currently use this classification.

This study qualitatively evaluated the impact of collaborative virtual educational activities designed to disseminate the concepts underlying the topographic classification on the surgical practice of PAS teams. Over a six-month period in 2024, interactive weekly webinars were conducted to discuss the evolving concepts in PAS that justify a shift toward precision medicine. Six months after the webinars concluded, a structured survey documented participants' perceptions of the impact of these sessions on the management of their PAS patients.

A total of 112 invitations to participate in the survey were sent, and 91 responses were received (response rate: 81.2%). Among respondents, 97% (n = 88) reported that participation in the virtual academic discussions led to some change in their clinical practice. Thirty-four participants (37.4%) indicated that, following the webinars, they felt more confident proposing modifications to the management of patients at risk for PAS within their institutions. Participants reported that following the virtual academic discussions, they intended to use ultrasonographic evaluation to plan surgery (13 participants, 14.2%), implement individualized management based on topographic classification (18 participants, 19.8%), perform bladder dissection prior to fetal delivery in order to confirm placenta accreta spectrum (PAS) and assess its topography before selecting the appropriate treatment approach (8 participants, 8.8%).

Virtual academic meetings designed to disseminate the PAS topographic classification fostered global collaboration, improved clinical practice, and enhanced mutual learning among PAS teams. Beyond technology, respectful, interactive discussions created a psychologically safe learning environment. Teleconferencing proved invaluable for education, research, and quality improvement, with continued support from professional societies essential for sustained progress.