Importance of placental evaluation in pregnancies at high risk for placenta accreta spectrum: Expert clinical perspective

Background: Placenta accreta spectrum (PAS) is a leading cause of obstetric morbidity and peripartum hysterectomy. Rising cesarean delivery rates, advanced maternal age, and assisted reproductive technologies have increased its incidence. Early, standardized diagnosis is essential for multidisciplinary planning and improved outcomes, yet formal screening guidelines are lacking. Objective: To raise awareness of the importance of antenatal screening for PAS, summarize key clinical and imaging risk factors, and propose a standardized mid-trimester ultrasound protocol for high-risk patients. Methods: An expert panel convened under the Pan-American Society for the Placenta Accreta Spectrum (PAS2) reviewed available evidence, risk stratification models, and prior consensus statements to develop practical recommendations for PAS screening. Results: PAS risk rises with the number of prior cesarean deliveries, especially in the setting of concurrent placenta previa or anterior low-lying placenta. Combined transabdominal and transvaginal ultrasound using grayscale and low-flow color Doppler (