Multidisciplinary Management of Morbidly Adherent Placenta Reduces Blood Loss [38N]

Abstract

INTRODUCTION: We implemented a multidisciplinary team approach including prophylactic internal iliac artery (IIA) catheterization to manage patients at high risk of obstetric hemorrhage due to morbidly adherent placentation (MAP). METHODS: We performed an IRB approved, retrospective cohort study of patients (2000-2018) who underwent cesarean hysterectomy for suspected MAP. We compared outcomes before and after the implementation of a multidisciplinary treatment team approach with data from the electronic medical record. RESULTS: There were 12 cases of MAP prior to implementation of the multidisciplinary approach and 24 cases after. IIA catheters were placed preoperatively in 54% of the patients in the multidisciplinary team cohort. There were no differences between groups in mean maternal age (35.2 vs 31.7, P=.14), gravidity (4.4 vs 3.8, P=.51), parity (2.6 vs 1.9, P=.12), or number of prior cesareans (2.5 vs 1.8, P=.09). There were no differences in postoperative length of stay (9.7 vs 4.8 days, P=.09), 30-day readmission (8.3% vs 12.5%, P=.071), 5 minute Apgar <7 (P=.16) or birth weight (P=.88). We observed a significant difference in estimated blood loss (4,558 mL vs 2,215 mL, P=.02) and mean number of units of packed red blood cells transfused (12.75 vs 4.5, P=.03). CONCLUSION: The multidisciplinary approach, specifically the addition of IIA catheterization, results in reduced total blood loss and units of blood transfused. This intervention may be high yield at other centers.

Fetomaternal Outcome in Morbidly Adherent Placenta

“…The prevalence of MAP has increased globally, mostly as a result of the steady rise in C-section rates. Prior vaginal delivery is less probable than prior C-section to be associated with placenta previa (implantation of placenta in lower uterine segment) 5,6 .…”