Implementation and outcomes of a uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum

Munoz, Jessian L.; Blankenship, Logan; Ramsey, Patrick S.; McCann, Georgia A.

doi:10.1016/j.ajog.2023.03.028

Cited by 9 publications

(3 citation statements)

References 31 publications

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“…A study by Munoz et al in 2023 demonstrates that UAE increases perioperative outcome and reduces maternal morbidity. However, the authors state that with UAE operative times were longer (416 vs. 187 min; p < 0.01) and patients were more likely to receive general anesthesia (80 vs. 47%; p < 0.01) compared to standard care [27]. In our study, mean times for caesarean delivery (33.5 (±13.7) minutes) and UAE (71.8 (±39.1) minutes) were shorter.…”

Section: Discussionmentioning

confidence: 49%

“…A pre-and post-implementation analysis of Munoz et al of UAE revealed a decreased blood loss by 33% (2000 vs. 3000 mL; p = 0.03) and decreased RBC transfusion rate by 51% (odds ratio (OR) 0.05 [95% CI 0.001-0.20]; p < 0.01) [27]. In contrast, a comparative study on women with PAS undergoing cesarean delivery with and without subsequent UAE reveals that UAE was associated with a higher blood loss than without UAE (2000 (1500-3000) vs. 1000 (600-2000) mL; p = 0.001) [28].…”

Section: Discussionmentioning

confidence: 99%

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Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

Neef,

Flinspach,

Eichler

et al. 2024

JCM

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Background: Placenta accreta spectrum (PAS) disorders are a continuum of placental pathologies with increased risk for hemorrhage, blood transfusion and maternal morbidity. Uterine artery embolization (UAE) is a safe approach to the standardization of complex PAS cases. The aim of this study is to analyze anemia and transfusion rate, outcome and anesthesiological management of women who underwent caesarean delivery with subsequent UAE for the management of PAS. Material and Methods: This retrospective observational study included all pregnant women admitted to the University Hospital Frankfurt between January 2012 and September 2023, with a diagnosis of PAS who underwent a two-step surgical approach for delivery and placenta removal. Primary procedure included cesarean delivery with subsequent UAE, secondary procedure included placenta removal after a minim of five weeks via curettage or HE. Maternal characteristics, anesthesiological management, complications, anemia rate, blood loss and administration of blood products were analyzed. Results: In total, 17 women with PAS were included in this study. Of these, 5.9% had placenta increta and 94.1% had placenta percreta. Median blood loss was 300 (200–600) mL during primary procedure and 3600 (450–5500) mL during secondary procedure. In total, 11.8% and 62.5% of women received red blood cell transfusion during the primary and secondary procedures, respectively. After primary procedure, postpartum anemia rate was 76.5%. The HE rate was 64.7%. Regional anesthesia was used in 88.2% during primary procedure. Conclusion: The embolization of the uterine artery for women diagnosed with PAS is safe. Anemia management and the implementation of blood conservation strategies are crucial in women undergoing UAE for the management of PAS.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

Neef,

Flinspach,

Eichler

et al. 2024

JCM

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“…Thus, after delivery of the neonate, the hysterotomy was closed and UAE was performed prior to the hysterectomy. This approach has been reported by our team [22].…”

Section: Surgical Approachmentioning

confidence: 73%

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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Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum

Munoz,

Cheng,

McCann

et al. 2024

Intl J Gynecology & Obste

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ObjectivePlacenta accreta spectrum (PAS) is a complex disorder of uterine wall disruption with significant morbidity and mortality, particularly at time of delivery. Both physician and physical hospital resource allocation/utilization remains a challenge in PAS cases including intensive care unit (ICU) beds. The primary objective of the present study was to identify preoperative risk factors for ICU admission and create an ICU admission prediction model for patient counseling and resource utilization decision making in an evidence‐based manner.MethodsThis was a case–control study of 145 patients at our PAS referral center undergoing cesarean hysterectomy for PAS. Final confirmation by histopathology was required for inclusion. Patient disposition after surgery (ICU vs post‐anesthesia care unit) was our primary outcome and pre‐/intra‐/postoperative variables were obtained via electronic medical records with an emphasis on the predictive capabilities of the preoperative variables. Uni‐ and multivariate analysis was performed to identify independent predictive factors for ICU admission.ResultsIn this large cohort of 145 patients who underwent cesarean hysterectomy for PAS, with histopathologic confirmation, 63 (43%) were admitted to the ICU following delivery. These patients were more likely to be delivered at an earlier gestational age (34 vs 35 weeks, P < 0.001), have had >2 episodes of vaginal bleeding and emergent delivery compared to patients admitted to patients with routine recovery care (44% vs 18.3%, P = 0.009). Uni‐ and multivariate logistic regression showed an area under the curve of 0.73 (95% CI: [0.63, 0.81], P < 0.001) for prediction of ICU admission with these three variables. Patients with all three predictors had 100% ICU admission rate.ConclusionResource prediction, utilization and allocation remains a challenge in PAS management. By identifying patients with preoperative risk factors for ICU admission, not only can patients be counseled but this resource can be requested preoperatively for staffing and utilization purposes.

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Implementation and outcomes of a uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum

Cited by 9 publications

References 31 publications

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

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

Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum

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