Maternal Morbidity in Patients With Morbidly Adherent Placenta Treated With and Without a Standardized Multidisciplinary Approach

Shamshirsaz, Amir A.; Fox, Karin A.; Salmanian, Bahram; Diaz-Arrastia, Concepcion; Lee, W.; Baker, B. Wycke; Ballas, Jerasimos; Chen, Q.; Veen, Teelkien R. van; Javadian, Pouya; Sangi‐Haghpeykar, Haleh; Zacharias, Nikolaos; Welty, Stephen E.; Cassady, Christopher I.; Moaddab, Amir; Popek, Edwina J.; Hui, S.-K. Rocky; Teruya, Jun; Bandi, Venkata; Coburn, Michael; Cunningham, Thomas J.; Martin, Stéphanie; Belfort, Michael A.

doi:10.1097/01.aoa.0000479507.50612.2a

Cited by 16 publications

(33 citation statements)

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“…69 Similarly, the median number of units of blood transfused is five 69 and many women require multiple units of blood and other blood products. [69][70][71][72][73] In a series of 76 cases from Utah, 28% had disseminated intravascular coagulation. 70 Maternal morbidity is common and 25-50% of patients are admitted to an intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

“…74 Most recent large series have lower rates of maternal death. [69][70][71][72][73] However, maternal deaths are likely underreported.…”

Section: Discussionmentioning

confidence: 99%

“…The average gestational age of delivery of accretas is typically 34-36 weeks of gestation, typically as a result of medically indicated preterm birth. 70,71,73,78 …”

Section: Discussionmentioning

confidence: 99%

“…Several studies confirm decreased hemorrhage and other maternal complications in cases diagnosed antenatally rather than intrapartum. [70][71][72][73] Prenatal diagnosis allows for optimal management, which typically includes planned cesarean hysterectomy before the onset of labor or bleeding. The hysterotomy (often fundal) is made with care to avoid transecting the placenta and no attempt is made to remove the placenta.…”

Section: Managementmentioning

confidence: 99%

“…Simply avoiding an attempt at placental removal can dramatically reduce the amount of bleeding as well as other complications. [70][71][72][73] In addition, prenatal diagnosis allows for delivery to be arranged in a center that is best suited to care for women with accreta. Several recent studies demonstrate improved outcomes and fewer complications in cases managed at such centers.…”

Section: Managementmentioning

confidence: 99%

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Abnormal Placentation

Silver¹

2015

Obstetrics &Amp; Gynecology

393

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Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology. The routine use of obstetric ultrasonography as well as improving ultrasonographic technology allows for the antenatal diagnosis of these conditions. In turn, antenatal diagnosis facilitates optimal obstetric management. This review emphasizes an evidence-based approach to the clinical management of pregnancies with these conditions as well as highlights important knowledge gaps.

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Section: Discussionmentioning

confidence: 99%

“…74 Most recent large series have lower rates of maternal death. [69][70][71][72][73] However, maternal deaths are likely underreported.…”

Section: Discussionmentioning

confidence: 99%

“…The average gestational age of delivery of accretas is typically 34-36 weeks of gestation, typically as a result of medically indicated preterm birth. 70,71,73,78 …”

Section: Discussionmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Abnormal Placentation

Silver¹

2015

Obstetrics &Amp; Gynecology

393

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Clinical Outcomes of a False-Positive Antenatal Diagnosis of Placenta Accreta Spectrum

et al. 2021

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Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

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Patient Perception of Care, Outcomes, and Consequences from Placenta Accreta Spectrum: A Survey-Based Study

et al. 2022

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Objective: Placental accreta spectrum (PAS) is an obstetric diagnosis that carries significant risks. However, little is known about patient perceptions of care. This study was conducted to describe the patient experience, reported outcomes, and assess geographical variation in PAS care in the United States. Study Design: Partnering with a PAS patient advocacy organization, we conducted an online survey of PAS patients. Perceptions of care and outcomes, and geographic variation were described. Results: We received 108 responses (69% response rate); 103 respondents delivered in the US. Demographic characteristics were similar across each region. Most (67%) reported at least one prior cesarean delivery and 53% reported placenta previa in the PAS pregnancy. Over half (63%) reported an antenatal suspicion of PAS and 66% of those respondents reported changing their delivery hospital a result of their antenatal diagnosis. Though not statistically significant, both showed variability across regions (both p≥0.60). Seventy-five percent of respondents with antenatal diagnosis reported their pregnancy was managed by a dedicated PAS care team, which did not differ by region (p=0.80). A majority of respondents (75%) felt their PAS care team was prepared for their delivery; this too did not vary across regions (p=0.97). Many respondents reported at least one physical (63%) or mental health (17%) adverse outcome as a result of their PAS pregnancy. Conclusions: As reported by prior PAS patients, perception of care and outcomes are overall favorable. There are long-term physical and mental adverse consequences reported. Geographical variation is mixed, however; national guidelines are predominately followed.

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Maternal Morbidity in Patients With Morbidly Adherent Placenta Treated With and Without a Standardized Multidisciplinary Approach

Cited by 16 publications

References 0 publications

Abnormal Placentation

Abnormal Placentation

Clinical Outcomes of a False-Positive Antenatal Diagnosis of Placenta Accreta Spectrum

Patient Perception of Care, Outcomes, and Consequences from Placenta Accreta Spectrum: A Survey-Based Study

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