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Improved management of placenta accreta spectrum disorders: experience from a single institution

  • Kendra Sylvester-Armstrong , Callie Reeder ORCID logo , Kathryn Patrick and Mehmet R. Genc EMAIL logo
Published/Copyright: December 16, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 50 Issue 3

Abstract

Objectives

To assess the applicability of a standardized multidisciplinary protocol for managing placenta accreta spectrum (PAS) disorders and its impact on the outcomes.

Methods

We compared patients with PAS manage by a standardized multidisciplinary protocol (T2) to historic controls managed on a case-by-case basis by individual physicians between (T1). The primary outcome is composite maternal morbidity. Secondary outcomes were the rates of surgical complications, estimated blood loss, number of blood products transfused, intensive care unit admissions, ventilator use, and birth weight. Multivariate logistic analysis was used to identify independent predictors of composite maternal morbidity.

Results

During T1 and T2, we managed 39 and 36 patients with confirmed PAS, respectively. During T2, the protocol could be implemented in 21 cases (58%). Compared to T1, patients managed during T2 had 70% less composite maternal morbidity (95% CI: 0.11–0.82) and lower blood loss (median, 2,000 vs. 1,100 mL, p=0.008). Also, they were 68% less likely to require transfusion of blood products (95% CI: 0.12–0.81; p=0.01), including fewer units of packed red blood cells (median, 2 vs. 0, p=0.02). Management following the protocol was the only independent factor associated with lower composite maternal morbidity (OR: 0.22; 95% CI: 0.05–0.95; p=0.04). Selected maternal and neonatal outcomes were not different among 12 and 15 patients with suspected but unconfirmed PAS disorders managed during T1 and T2, respectively.

Conclusions

Most patients can be managed under a standardized multidisciplinary protocol for PAS disorders, leading to improved outcomes.

Keywords: cesarean hysterectomy; placenta accreta spectrum; postpartum hemorrhage; standardized multidisciplinary protocol
Corresponding author: Mehmet Genc, MD, PhD, Professor, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL 32610-0294, USA, Phone: 352 273 7685, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The local Institutional Review Board approved the study.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0263).

Received: 2021-05-23
Accepted: 2021-11-29
Published Online: 2021-12-16
Published in Print: 2022-03-28

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
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  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
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  23. Short Communication
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  25. Letter to the Editors
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  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
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https://doi.org/10.1515/jpm-2021-0263
Keywords for this article
cesarean hysterectomy; placenta accreta spectrum; postpartum hemorrhage; standardized multidisciplinary protocol

Articles in the same Issue

  1. Frontmatter
  2. Corner of Academy
  3. Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies
  4. Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis
  5. Original Articles – Obstetrics
  6. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls
  7. The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety
  8. First-line noninvasive management of cytomegalovirus primary infection in pregnancy
  9. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
  11. A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  12. The impact of preimplantation genetic testing for aneuploidy on prenatal screening
  13. Original Articles – Fetus
  14. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study
  15. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation
  16. Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13
  17. Original Articles – Neonates
  18. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation
  19. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States
  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
  21. High frequency band limits in spectral analysis of heart rate variability in preterm infants
  22. Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis
  23. Short Communication
  24. Healthcare workers’ attitudes about vaccination of pregnant women and those wishing to become pregnant
  25. Letter to the Editors
  26. Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  28. SARS-CoV-2 behavior, through the eyes of a perinatologist?
  29. Re: SARS-CoV-2 behavior, through the eyes of a perinatologist?
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