Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care

Fitzgerald, Garrett D.; Newton, J.M.; Atasi, Lamia; Buniak, Christina M.; Burgos-Luna, Juan Manuel; Burnett, Brian A.; Carver, Alissa R.; Cheng, CeCe; Conyers, Steffany; Davitt, Caroline; Deshmukh, Uma; Donovan, Bridget M.; Easter, Sara Rae; Einerson, Brett D.; Fox, Karin A.; Habib, Ashraf S.; Harrison, Rachel; Hecht, Jonathan L.; Licon, Ernesto; Nino, Julio Mateus; Munoz, Jessian L.; Nieto-Calvache, Albaro Jose; Polic, Aleksandra; Ramsey, Patrick S.; Salmanian, Bahram; Shamshirsaz, Alireza A.; Shamshirsaz, Amir A.; Shrivastava, Vineet K.; Woolworth, Melissa B.; Yurashevich, Mary; Zuckerwise, Lisa; Shainker, Scott A.

doi:10.1016/j.ajogmf.2023.101229

Cited by 5 publications

(1 citation statement)

References 147 publications

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“…Early diagnosis of PAS is imperative to allow for delivery to occur at a high-resource medical center [14]. These cases require a multi-disciplinary approach, often including maternal-fetal medicine, neonatology, anesthesiology, urology, and gynecologic oncology [15].…”

Section: Introductionmentioning

confidence: 99%

Association between Antenatal Vaginal Bleeding and Adverse Perinatal Outcomes in Placenta Accreta Spectrum

Mulhall,

Ireland,

Byrne

et al. 2024

Medicina

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Background and Objectives: Placenta accreta spectrum (PAS) disorders are placental conditions associated with significant maternal morbidity and mortality. While antenatal vaginal bleeding in the setting of PAS is common, the implications of this on overall outcomes remain unknown. Our primary objective was to identify the implications of antenatal vaginal bleeding in the setting of suspected PAS on both maternal and fetal outcomes. Materials and Methods: We performed a case-control study of patients referred to our PAS center of excellence delivered by cesarean hysterectomy from 2012 to 2022. Subsequently, antenatal vaginal bleeding episodes were quantified, and components of maternal morbidity were assessed. A maternal composite of surgical morbidity was utilized, comprised of blood loss ≥ 2 L, transfusion ≥ 4 units of blood, intensive care unit (ICU) admission, and post-operative length of stay ≥ 4 days. Results: During the time period, 135 cases of confirmed PAS were managed by cesarean hysterectomy. A total of 61/135 (45.2%) had at least one episode of bleeding antenatally, and 36 (59%) of these had two or more bleeding episodes. Increasing episodes of antenatal vaginal bleeding were associated with emergent delivery (p < 0.01), delivery at an earlier gestational age (35 vs. 34 vs. 33 weeks, p < 0.01), and increased composite maternal morbidity (76, 84, and 94%, p = 0.03). Conclusions: Antenatal vaginal bleeding in the setting of PAS is associated with increased emergent deliveries, earlier gestational ages, and maternal composite morbidity. This important antenatal event may aid in not only counseling patients but also in the coordination of multidisciplinary teams caring for these complex patients.

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Section: Introductionmentioning

confidence: 99%