Assessing the multidisciplinary team approaches to placenta accreta spectrum across five institutions within the University of California fetal Consortium (UCfC)

Fratto, Victoria; Conturie, Charlotte L.; Ballas, Jerasimos; Pettit, Katie; Stephenson, Megan; Truong, Yen N.; Henry, Dana; Afshar, Yalda; Murphy, Aisling; Kim, Lena; Field, Nancy T.; Norton, Mary E.; Ramos, Gladys A.

doi:10.1080/14767058.2019.1676411

Cited by 23 publications

(13 citation statements)

References 31 publications

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“…Optimal conditions for delivery in PAS have been described, including thorough prenatal consultation and management by experienced multidisciplinary teams in large perinatal centres [14,15]. According to current knowledge, the expertise of a wellcoordinated team seems to be more decisive than the specific type of procedure [16,17].…”

Section: Introductionmentioning

confidence: 99%

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Bluth

Schindelhauer

Nitzsche

et al. 2020

Arch Gynecol Obstet

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Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

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Section: Introductionmentioning

confidence: 99%

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Bluth

Schindelhauer

Nitzsche

et al. 2020

Arch Gynecol Obstet

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“…Cesarean delivery rates have increased steadily over the years in many countries, and this increase has also led to an increase in the prevalence of PAS worldwide [6,23]. Due to this increase in PAS frequency, centers have created management strategies to reduce maternal morbidity [12,24]. Studies have shown that a predefined management strategy reduces morbidity from PAS.…”

Section: Discussionmentioning

confidence: 99%

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center

Gölbaşı

Bayraktar

Gölbaşı

et al. 2022

Z Geburtshilfe Neonatol

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Objectives To evaluate the maternal and neonatal outcomes of expected and unexpected pathologically proven placenta accreta spectrum (PAS) cases in a single multidisciplinary center. Material and Methods This was a retrospective cohort study of 92 PAS cases from January 2011 until September 2021. Only cases with histopathologically invasive placentation were included in the study. The cases diagnosed at the time of delivery were defined as unexpected PAS (uPAS) and those diagnosed antenatally as expected PAS (ePAS). Maternal and neonatal outcomes of both groups were compared. Results Thirty-five (38%) of 92 cases were in the uPAS group. Placenta previa and high-grade PAS (percreata) were significantly higher in the ePAS group (p=0.028, p<0.001; respectively). The mean packed red blood cell transfusion was significantly higher in the uPAS group (p=0.030) but transfusions of other blood products were similar in the two groups. There was no significant difference in intraoperative complication rates between the two groups. Preterm delivery (<37 weeks) was significantly higher in the ePAS group (p<0.001), but there was no significant difference between the two groups in terms of adverse neonatal outcomes. Conclusions Our single center data show that although ePAS cases include more highly invasive PAS cases, maternal hemorrhagic morbidity is lower than uPAS cases. Reducing maternal morbidity in PAS cases can be achieved by increasing antenatal diagnosis.

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“…These methods include applications requiring interventional radiology such as prophylactic balloon catheter occlusion (uterine artery, internal iliac artery, common iliac artery, aorta), embolization of uterine or internal iliac artery. [3,11,[19][20][21][22][23] Although there is not enough data in the literature on the effectiveness of these methods, there are cases where serious complications have been reported in the literature. [20,24,25] Our hospital does not have an interventional radiologist experienced in these issues.…”

Section: Discussionmentioning

confidence: 99%

Comparison of conservative and radical surgery in the management of placenta previa percreta

Sezgin¹,

Kasap²,

Şahin³

et al. 2021

Perinatal J

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Objective We aimed to compare the uterine sparing (US) surgery and hysterectomy for placenta previa percreta (PPP) management. Methods Data from PPP patients with anterior invasion who underwent US surgery and caesarean hysterectomy were retrospectively analyzed. The clinical and surgical outcomes of patients with PPP were compared according to the type of surgery. Results The mean intraoperative blood loss was lower in US surgery group than in caesarean hysterectomy group (1227.78±204.80 ml vs 1442.22±125.68 ml; p=0.017). The hemoglobin drop was also significantly lower in the patients with US surgery (1.87±0.68 g/dl vs 2.88±1.04 g/dl; p=0.026). Moreover, the mean total transfusion rate was also significantly lower in the patients with US surgery (1.33±0.87 U vs 2.33±0.71 U; p=0.016). Conclusion Uterine sparing surgery reduces intraoperative blood loss and transfusion rate in PPP patients with anterior placental invasion compared to hysterectomy. The temporary blockage of bilateral uterine and uteroovarian arteries with Satinsky clamps may potentially contribute to the success of US surgery.

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Assessing the multidisciplinary team approaches to placenta accreta spectrum across five institutions within the University of California fetal Consortium (UCfC)

Cited by 23 publications

References 31 publications

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center

Comparison of conservative and radical surgery in the management of placenta previa percreta

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