Implementation of multidisciplinary practice change to improve outcomes for women with placenta accreta spectrum

Licon, Ernesto; Matsuzaki, Shinya; Opara, Karen N.; Ng, Adrian J Y; Bender, Nicole; Grubbs, Brendan H.; Lee, Richard H.; Ouzounian, Joseph G.; Pham, Huyen Q.; Brunette, Laurie L.; Yessaian, Annie A.; Ciccone, Marcia A.; Muderspach, Laila I.; Roman, Lynda D.; Sasso, Elizabeth B.; Matsuo, Koji

doi:10.1016/j.ejogrb.2020.01.010

Cited by 11 publications

(7 citation statements)

References 6 publications

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“…For women with placenta accreta spectrum disorder (PASD), massive hemorrhage is a severe complication, with intraoperative blood loss possibly exceeding several liters and leading to disseminated intravascular coagulation and, ultimately, maternal death [ 1 , 2 , 3 , 4 ]. There is also a high risk of bladder injury and ureter injury; therefore, cesarean hysterectomy without any attempt to remove the placenta is often required to avoid these complications [ 2 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

et al. 2022

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This study aimed to assess the relationship between placenta accreta spectrum disorder (PASD) and endometriosis. The relationships among pregnancy, assisted reproductive technology (ART), placenta previa, ART-conceived pregnancy and PASD were also determined. A systematic literature review was conducted using multiple computerized databases. Forty-eight studies (1990–2021) met the inclusion criteria. According to the adjusted pooled analysis (n = 3), endometriosis was associated with an increased prevalence of PASD (adjusted odds ratio [OR] 3.39, 95% confidence interval [CI] 1.96–5.87). In the included studies, the ART rate ranged from 18.2% to 37.2% for women with endometriosis. According to the adjusted pooled analysis, women who used ART were more likely to have placenta previa (n = 13: adjusted OR 2.96, 95%CI, 2.43–3.60) and PASD (n = 4: adjusted OR 3.54, 95%CI 1.86–6.76) than those who did not use ART. According to the sensitivity analysis using an unadjusted analysis accounting for the type of ART, frozen embryo transfer (ET) was associated with an increased risk of PASD (n = 4: OR 2.79, 95%CI, 1.22−6.37) compared to fresh ET. Endometriosis may be associated with an increased rate of PASD. Women with placenta previa complicated with endometriosis who conceived using frozen ET may be a high risk for PASD.

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Section: Introductionmentioning

confidence: 99%

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

et al. 2022

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“…The introduction of a coordinated multidisciplinary approach at this public referral hospital has contributed to a reduced rate of urgent deliveries and allowed for an increased scheduling of deliveries in women with PAS. Several studies have emphasized the role of multidisciplinary care in improving outcomes and reducing both maternal and neonatal morbidity and mortality [ 2 , 13 , 14 , 31 , 32 , 39 ]. In Lebanon and other lower-middle income countries, the management of PAS in resource-limited settings is still challenging [ 26 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Obstetric and haematological management and outcomes of women with placenta accreta spectrum by planned or urgent delivery: Secondary data analysis of a public referral hospital in Lebanon

McCall,

Mansour,

Khazaal

et al. 2024

PLoS ONE

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Background Lebanon has a high caesarean section use and consequently, placenta accreta spectrum (PAS) is becoming more common. Objectives To compare maternal characteristics, management, and outcomes of women with PAS by planned or urgent delivery at a major public referral hospital in Lebanon. Design Secondary data analysis of prospectively collected data. Setting Rafik Hariri University Hospital (public referral hospital), Beirut, Lebanon. Participants 159 pregnant and postpartum women with confirmed PAS between 2007–2020. Main outcome measures Maternal characteristics, management, and maternal and neonatal outcomes. Results Out of the 159 women with PAS included, 107 (67.3%) underwent planned caesarean delivery and 52 (32.7%) had urgent delivery. Women who underwent urgent delivery for PAS management were more likely to experience antenatal vaginal bleeding compared to those in the planned group (55.8% vs 28.0%, p<0.001). Median gestational age at delivery was significantly lower for the urgent group compared to the planned (34 vs. 36 weeks, p<0.001). There were no significant differences in terms of blood transfusion rates and major maternal morbidity between the two groups; however, median estimated blood loss was significantly higher for women with urgent delivery (1500ml vs. 1200ml, p = 0.011). Furthermore, the urgent delivery group had a significantly lower birth weight (2177.5g vs. 2560g, p<0.001) with higher rates of neonatal intensive care unit (NICU) admission (53.7% vs 23.8%, p<0.001) and perinatal mortality (18.5% vs 3.8%, p = 0.005). Conclusion Urgent delivery among women with PAS is associated with worse maternal and neonatal outcomes compared to the planned approach. Therefore, early referral of women with known or suspected PAS to specialized centres is highly desirable to maximise optimal outcomes for both women and infants.

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“…For those survey respondents who did participate in hysterectomies for placenta accreta spectrum, about half (49.7%) were present at the beginning of the case, while only 5% were just available on call as needed. This is encouraging because active involvement of a gynecologist oncologist at the beginning of the case has been linked to improved surgical outcomes and lower intraoperative blood loss 8 12. It is unknown whether the complexity of the case, the resource constraints of the workplace setting, or local practices influence when the gynecologic oncologist becomes involved.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have outlined criteria for hospitals to be centers-of-excellence for placenta accreta spectrum, including a multidisciplinary team approach with gynecologic oncologists,9 and surgical techniques to improve outcomes 10. A few studies have evaluated single-center experiences with multidisciplinary teams 11 12. It is not clear, however, how often these recommendations are implemented at hospitals across the USA.…”

Section: Introductionmentioning

confidence: 99%

Gynecologic oncologists in surgery for placenta accreta spectrum: a survey for practice, experience, and interest

Matsuo

Vestal

Rau

et al. 2022

Int J Gynecol Cancer

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ObjectiveSurgery for placenta accreta spectrum is associated with significant maternal morbidity and mortality. The role of gynecologic oncologists in the surgical management of placenta accreta spectrum is currently under investigation. This study examined the practices, experiences, and interests of gynecologic oncologists in placenta accreta spectrum surgeries.MethodsThe intervention was an anonymous, cross-sectional, 20-question survey sent to 1084 members of the Society of Gynecologic Oncology in the USA.ResultsA total of 184 gynecologic oncologists responded to the survey (response rate 17.0%). Most participating gynecologic oncologists have been practicing for >10 years after fellowship (53.2%), practice in urban-teaching hospitals (84.8%) with delivery volumes ≥3000/year (54.3%), and have a multidisciplinary approach (82.5%). Three-quarters (78.7%) feel that the rate of placenta accreta spectrum is increasing over time. One-third (35.5%) perform ≥6 hysterectomies for placenta accreta spectrum yearly. Less than half (45.5%) practice conservative management. Approximately half are involved from the beginning of the case (49.7%) and perform the surgery in the main operating room (59.4%). Almost three-quarters (71.6%) have experienced surgical blood loss >5 L and one-third (36.6%) have experienced cases with blood loss >10 L. About half (50.3%) of participants are interested in placenta accreta spectrum surgery for future practice. Gynecologic oncologists engaging in a multidisciplinary approach are more likely to practice in an urban-teaching hospital, have higher surgical volume, be involved from the beginning of the case, and be interested in placenta accreta spectrum surgery. Those >10 years post-training and in the Southern US region are more likely to practice conservative management or delayed hysterectomy.ConclusionThis society-based cross-sectional survey suggests that gynecologic oncologists are actively involved in the surgical management of placenta accreta spectrum in the USA. Nearly half of gynecologic oncologists who responded to the survey expressed interest in surgery for placenta accreta spectrum.

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Implementation of multidisciplinary practice change to improve outcomes for women with placenta accreta spectrum

Cited by 11 publications

References 6 publications

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

Obstetric and haematological management and outcomes of women with placenta accreta spectrum by planned or urgent delivery: Secondary data analysis of a public referral hospital in Lebanon

Gynecologic oncologists in surgery for placenta accreta spectrum: a survey for practice, experience, and interest

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