What criteria should I use to determine when to refer a patient with placenta praevia to a specialist?

Criteria for referral of a patient with placenta praevia to a specialist include:

• When placenta accreta spectrum is suspected on ultrasound, refer the woman to a specialist placenta accreta spectrum centre for care and ongoing management. This should be done after a greyscale ultrasound scan with colour Doppler, ideally performed by a senior clinician around 28 to 29 weeks gestation.
• Referral is indicated if there is suspicion of abnormal placental invasion (placenta accreta spectrum), as these cases require multidisciplinary specialist management including planning for delivery and potential surgical interventions.
• Discuss birth options and management plans with a senior obstetrician experienced in placenta accreta spectrum if suspected, and ensure referral to a centre with appropriate multidisciplinary teams and resources (including access to adult intensive care, neonatal care, and blood products).
• Referral should also be considered if there are complications or concerns that exceed routine antenatal care capabilities, such as significant bleeding or suspicion of invasive placentation.

In summary, any placenta praevia case with suspicion or diagnosis of placenta accreta spectrum, or complex clinical features, should be referred to a specialist placenta accreta spectrum centre for expert assessment and management.

References: NICE NG192