A systematic multidisciplinary initiative may reduce the need for blood products in patients with abnormally invasive placenta

Nieto-Calvache, Álbaro José; López-Girón, María Camila; Quintero-Santacruz, Marcela; Bryon, Adriana Messa; Burgos‐Luna, Juan Manuel; Echavarría-David, María Paula; López, Leidy; Macia-Mejia, Carmenza; Benavides‐Calvache, Juan Pablo

doi:10.1080/14767058.2020.1731460

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…There is evidence that frequent performance of complex procedures is associated with better results 14 . Previous observations in our population demonstrate this by requiring fewer transfusions 15 and hysterectomies, 10 and by presenting fewer operative complications 16 . This coincides with the recommendations of other authors to favor fixed interdisciplinary groups for the management of PAS 17 …”

Section: Discussionsupporting

confidence: 87%

A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum

Nieto-Calvache

Vergara-Galliadi

Rodríguez

et al. 2021

J Trauma Acute Care Surg

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The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a PAS team. METHODOLOGY:A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way. RESULTS:A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise. CONCLUSION:Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills.

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Section: Discussionsupporting

confidence: 87%

A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum

Nieto-Calvache

Vergara-Galliadi

Rodríguez

et al. 2021

J Trauma Acute Care Surg

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“…13 Similarly, the prevalence of 7.5% of irregular antibodies in patients with PAS requires the availability of a large number of RBCUs to maintain safety during a transfusion. 14 Although the exclusion of donors as a precaution and the national mandatory confinement partly explain the reduction in the blood bank inventory, 9 the most frequently mentioned reason for not donating blood is the fear of acquiring SARS-CoV-2 during the donation. 15 The cancellation of extramural campaigns using the MBDU was the most striking factor in the low frequency of donations.…”

Section: Discussionmentioning

confidence: 99%

“…Although other institutions accept a different number, the requirements for the care of a single patient with PPH due to PAS can deplete blood reserves rapidly since as many as 40% of cases require massive transfusions, with patients demanding up to 46 units of RBCU 13 . Similarly, the prevalence of 7.5% of irregular antibodies in patients with PAS requires the availability of a large number of RBCUs to maintain safety during a transfusion 14 …”

Section: Discussionmentioning

confidence: 99%

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Dangerous shortage of blood banks as an indirect effect of SARS‐CoV‐2: An obstetrics perspective

Nieto-Calvache

Quintero-Santacruz

Macia-Mejia

et al. 2020

Intl J Gynecology & Obste

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Objective: To describe the impact of the SARS-CoV-2 pandemic on the frequency of blood donation (BD) in a Latin American hospital and how the social isolation policy implemented during the pandemic jeopardizes the quality of postpartum hemorrhage (PPH) care due to shortages at blood banks (BB). Methods: A retrospective, descriptive study was conducted, lasting for 31 months, including the start of the pandemic. Frequency of BD and the use of obstetric emergency services was observed. Results: A direct relationship was observed between the pandemic and a decrease in BD. Although emergency obstetric visits decreased, the frequency of deliveries and cases of PPH remained unchanged. After applying strategies to promote voluntary BD, a very slight increase was observed in the frequency of BD, with a negative indicator persisting between donation and blood demand. Conclusion: The SARS-CoV-2 pandemic has led to shortages at BBs. In this context, typical measures to encourage an altruistic attitude toward BD have not had a significant impact. As causes of PPH continue, quality of care may be affected by the current situation at BBs. Governments and institutions must implement new strategies to motivate BD.

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“…AIP is a common complication in obstetrics and it is the leading cause of hysterectomies associated with caesarean delivery and peripartum hysterectomies ( 3 ). A standardized approach with a comprehensive multidisciplinary care team accustomed to the management of AIP is essential for favourable maternal and neonatal outcomes ( 4-6 ). The early diagnosis of pregnant females with AIP will provide more opportunities to receive multidisciplinary care and good perinatal outcomes ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Preliminary RNA‑microarray analysis of long non‑coding RNA expression in abnormally invasive placenta

Zhang

et al. 2020

Exp Ther Med

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Long non-coding RNAs (lncRNAs) are reported to have important roles in placental development and function, but the role of lncRNAs in abnormally invasive placenta (AIP) remains elusive. In the present study, the differential expression profiles of lncRNAs were analyzed to identify novel targets for further study of AIP. A total of 10 lncRNAs were chosen for validation by reverse transcription-quantitative PCR. To further determine the functions of dysregulated lncRNAs and their corresponding mRNAs, functional enrichment analysis, coexpression analysis were performed. A total of 329 lncRNAs and 179 mRNAs were identified to be differently expressed between the invasive and control group. Gene ontology analysis revealed that the 10 most significantly enriched functions included upregulated mRNAs and the most significantly enriched term was related to the proteinaceous extracellular matrix (ECM). In the pathway analysis, the two most significantly enriched pathways were the TGF-β signaling pathway for upregulated mRNAs and the pentose phosphate pathway for downregulated mRNAs. Furthermore, for certain dysregulated lncRNAs, their associated mRNAs were also dysregulated. Of note, BMP and activin membrane-bound inhibitor and TGF-β-induced, as the target genes of the TGF-β pathway, were indicated to be closely related to the ECM and invasive placental cells. Their nearby lncRNAs G008916 and vault RNA2-1 were also significantly dysregulated. In conclusion, significant lncRNAs with the potential to serve as biomarkers for AIP were identified.

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A systematic multidisciplinary initiative may reduce the need for blood products in patients with abnormally invasive placenta

Cited by 7 publications

References 22 publications

A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum

A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum

Dangerous shortage of blood banks as an indirect effect of SARS‐CoV‐2: An obstetrics perspective

Preliminary RNA‑microarray analysis of long non‑coding RNA expression in abnormally invasive placenta

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