Gynecologic oncologists in surgery for placenta accreta spectrum: a survey for practice, experience, and interest

Abstract

ObjectiveSurgery for placenta accreta spectrum is associated with significant maternal morbidity and mortality. The role of gynecologic oncologists in the surgical management of placenta accreta spectrum is currently under investigation. This study examined the practices, experiences, and interests of gynecologic oncologists in placenta accreta spectrum surgeries.MethodsThe intervention was an anonymous, cross-sectional, 20-question survey sent to 1084 members of the Society of Gynecologic Oncology in the USA.ResultsA total of 184 gynecologic oncologists responded to the survey (response rate 17.0%). Most participating gynecologic oncologists have been practicing for >10 years after fellowship (53.2%), practice in urban-teaching hospitals (84.8%) with delivery volumes ≥3000/year (54.3%), and have a multidisciplinary approach (82.5%). Three-quarters (78.7%) feel that the rate of placenta accreta spectrum is increasing over time. One-third (35.5%) perform ≥6 hysterectomies for placenta accreta spectrum yearly. Less than half (45.5%) practice conservative management. Approximately half are involved from the beginning of the case (49.7%) and perform the surgery in the main operating room (59.4%). Almost three-quarters (71.6%) have experienced surgical blood loss >5 L and one-third (36.6%) have experienced cases with blood loss >10 L. About half (50.3%) of participants are interested in placenta accreta spectrum surgery for future practice. Gynecologic oncologists engaging in a multidisciplinary approach are more likely to practice in an urban-teaching hospital, have higher surgical volume, be involved from the beginning of the case, and be interested in placenta accreta spectrum surgery. Those >10 years post-training and in the Southern US region are more likely to practice conservative management or delayed hysterectomy.ConclusionThis society-based cross-sectional survey suggests that gynecologic oncologists are actively involved in the surgical management of placenta accreta spectrum in the USA. Nearly half of gynecologic oncologists who responded to the survey expressed interest in surgery for placenta accreta spectrum.

Intraoperative temporary internal iliac arterial occlusion (Polat's technique) for severe placenta accreta spectrum: A description of the technique and outcomes in 61 patients

“…As the surgical management of PAS generally requires extensive retroperitoneal dissection, it is performed by gynecologic oncologists in many parts of the world. Cross‐sectional surveys in the USA indicate that gynecologic oncologists are actively involved in the surgical management of PAS 13 . The present study describes a technique with temporary occlusion of the hypogastric arteries by Bulldog vascular clamp to minimize intraoperative bleeding.…”

“…F I G U R E 8 Attachment of the bulldog clamp to the internal iliac vessels. EIA, external iliac artery; IIA, internal iliac artery.Cross-sectional surveys in the USA indicate that gynecologic oncologists are actively involved in the surgical management of PAS 13. The present study describes a technique with temporary occlusion of the hypogastric arteries by Bulldog vascular clamp to minimize intraoperative bleeding.…”

Roadmap to safety: a single center study of evidence-informed approach to placenta accreta spectrum

“…While gynecologic oncologists continue to navigate their role in managing PAS, institutions worldwide rely on gynecologic oncology at time of c-hyst for PAS ( 17 ). An important feature of our protocol was focused surgical training of a group of general obstetricians to manage PAS without routine gynecologic oncology participation.…”

Complex caesarean delivery

“…This is particularly concerning considering the increasing need for obstetricians to perform complex Caesarean deliveries. As a result, advanced pelvic surgeons and gynaecological oncologists are increasingly relied upon to manage these cases, in particular for conditions such as PAS [ [23] , [24] , [25] , [26] , [27] ]. While there are no pre-specified or standardised criteria of what defines competency to perform surgery for suspected PAS cases, a comprehensive understanding of pelvic anatomy, ability to meticulously dissect surgical plans and operate in the retroperitoneum is essential for such cases.…”

“…However, in the era of MIS surgery, combined with reduced training hours and an increased number of trainees, it is increasingly likely that the “experienced pelvic surgeon” with expertise to perform complex Caesarean delivery and PAS surgery will be the gynaecological oncologist. A survey of gynaecological oncologists in the United States suggests that just over half are interested in participating in PAS surgery [ 26 ].…”