Skip to main content
SMFM 2026 Pregnancy Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared outside of the session
Faculty have requested this content not be shared outside of the session
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
Poster Icons
Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 3

Category: Obstetric Quality and Safety

Poster Session 3

(844) SMM Rates in PAS – Time to revisit our SMM criteria

Thursday, February 12, 2026
10:30 AM - 12:00 PM  

    Submitting Author and Presenting Author(s)

  • Laura Diab, MD (she/her/hers)

    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • DA

    Diego Aviles, MD

    Division of Gynecology Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

    Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Joe Haydamous, MD (he/him/his)

    PGY1
    Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston, Texas, United States

  • Zakaria Doughan, MD

    Research Assistant
    Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston
    Houston, Texas, United States

  • Sean C. Blackwell, MBA, MD

    Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Baha M. Sibai, MD

    Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Farah H. Amro, MD

    Assistant Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective:

Severe maternal morbidity (SMM) is used as a quality metric. Current ACOG-SMFM criteria are not tailored to placenta accreta spectrum (PAS) since they include expected morbidity such as transfusion. Recently, PAS-specific SMM criteria were proposed. Our objective is to compare SMM rates in PAS using newly proposed PAS-specific versus ACOG-SMFM criteria.


Study Design:

A retrospective study at Level IV center (Jan 2015 to Jun 2025) of patients with ultrasound suspected PAS. Different PAS management approaches are utilized at our institution—cesarean hysterectomy (CH), delayed hysterectomy (DH) and leaving placenta in situ for uterine preservation (LPIS-UP). Patients undergoing CH or DH were included with pathologic confirmation of PAS, while LPIS-UP cases required intraoperative confirmation. Maternal outcomes were collected by chart review. SMM was compared between ACOG-SMFM and PAS-specific criteria.


Results:
A total of 173 met inclusion criteria: 129 had CH, 30 DH, and 14 LPIS-UP. Rate of SMM was higher using ACOG-SMFM criteria (71%, 123/173) compared to PAS-specific criteria (20%, 35/173; p < 0.05). The relative risk of SMM was 3.52 (95% CI: 2.6–4.8), indicating that ACOG-SMFM definition identified over three times as many cases. SMM defined by ACOG-SMFM was primarily driven by hemorrhage, while PAS-specific SMM was driven by transfusion ≥8 units pRBCs (Table 1). When stratified by management approach, rates of SMM under ACOG-SMFM vs. PAS-specific criteria were CH – 71% vs. 22%; DH – 87% vs. 23%; LPIS-UP – 43% vs. 0% (p = 0.02; Figure 1). Comparisons across management strategies showed significant differences using ACOG-SMFM criteria (70% vs. 87% vs. 38%, p = 0.01), but not with PAS-specific criteria (22% vs. 23% vs. 0%, p = 0.13).

Conclusion:

Applying PAS-specific severe maternal morbidity (SMM) criteria resulted in 51% reduction in reported SMM rate, redirecting focus toward complications uniquely associated with PAS. These findings support adoption of PAS-specific criteria in place of ACOG-SMFM definition, enabling more meaningful comparisons of outcomes across centers and management strategies.