Maternal and neonatal outcomes of women diagnosed with Placenta Accreta Spectrum Disorder managed by a standardized Multidisciplinary Team

Abstract

Purpose Placenta accreta spectrum disorder (PAS) is a pathological condition in which placenta abnormally adheres to or invades the myometrium. PAS has a high risk of complications, especially peripartum bleeding, which can be associated with several maternal and neonatal adverse outcomes. Our goal is to determine maternal and fetal outcomes in cases of PAS managed by a multidisciplinary team (MDT). Methods This is a retrospective cohort study that included all cases of PAS managed by a MDT between January 2016 and December 2022. Maternal and neonatal outcomes were analyzed for each case. Results There were 102 cases of PAS managed by a MDT during the study period. Maternal age average was 35.5 years, 75.4% had at least one prior cesarean section and 55.8% had placenta previa. 54.9% were diagnosed with placenta accreta, 20.5% with placenta increta and 24.5% with placenta percreta. Hysterectomy was performed in 55.8% of the cases, and in 87.7% of them placenta was left in situ. Blood products transfusion was necessary in 24.5% of the cases, with a mean number of 2 red blood cells concentrates. Intensive care unit admission rate after surgery was 8.8% and no maternal death occurred. Conclusions Although PAS is a condition associated with high morbidity and mortality, this study demonstrates lower rates of maternal complications than reported in literature. PAS management should be based in protocols, and pregnancy interruption should be performed in centers of excellence with an experienced and trained MDT, making it possible to reduce maternal morbidity and mortality.