Invasive placental disease: the impact of a multi-disciplinary team approach to management

Smulian, John C.; Pascual, Ana-Liza; Hesham, Helai; Qureshey, Emma J.; Thomas, Maria; DePuy, Amy M.; Flicker, Amanda B; Scorza, William E.

doi:10.1080/14767058.2016.1216099

Cited by 46 publications

(54 citation statements)

References 29 publications

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“…Multiple retrospective cohort studies of PAS disorders have documented reduced maternal morbidity when care is provided in centers of excellence (CoE) . The hallmark features of a CoE are listed in Table .…”

Section: Preparation For the Operative Management Of Invasive Placentmentioning

confidence: 99%

“…Operative times with MDTs may be significantly longer. Surgeries in a single center were 260 ± 68 minutes with the team and 181 ± 57 minutes in the absence of the MDT, likely as a result of introducing more aspects of care . It is also possible that the MDT becomes involved with the more complex cases that simply require more time to set up and perform.…”

Section: Preparation For the Operative Management Of Invasive Placentmentioning

confidence: 99%

“…Multiple retrospective cohort studies of PAS disorders have documented reduced maternal morbidity when care is provided in centers of excellence (CoE). 11,15,17,23 The hallmark features of a CoE are listed in Table 2. 24 While the exact components of care plans may vary from center to center, the common aspects remain a dedicated care plan and a multidisciplinary team (MDT) with surgical expertise capable of managing the full spectrum of accreta complexity.…”

Section: Multidisciplinary Team Carementioning

confidence: 99%

“…One study including a total 118 PAS disorder cases that compared two sequential time periods reported reductions in estimated blood T A B L E 1 Complications associated with surgery for placenta accreta spectrum (PAS) disorders. 23 It is also possible that the MDT becomes involved with the more complex cases that simply require more time to set up and perform. These longer operating times may affect resource utilization and are not available in low-income and most middle-income countries.…”

Section: Multidisciplinary Team Carementioning

confidence: 99%

“…In two additional retrospective cohorts, MDT care was associated with statistically lower rates of attempted placental removal and a reduction in blood transfusion rates, large-volume blood transfusion, and estimated blood loss for PAS disorders. 17,23 However, in select patients, intraoperative inspection of the uterus at cesarean delivery may allow a trial of placental separation in suspected cases of PAS disorders without increasing morbidity. 89 This study had a high rate of T A B L E 4 Novel techniques for cesarean hysterectomy in patients with placenta accreta spectrum (PAS) disorders.…”

Section: Placental Removalmentioning

confidence: 99%

See 4 more Smart Citations

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Allen

Jauniaux

Hobson

et al. 2018

Intl J Gynecology & Obste

290

282

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Section: Preparation For the Operative Management Of Invasive Placentmentioning

confidence: 99%

Section: Preparation For the Operative Management Of Invasive Placentmentioning

confidence: 99%

Section: Multidisciplinary Team Carementioning

confidence: 99%

Section: Multidisciplinary Team Carementioning

confidence: 99%

Section: Placental Removalmentioning

confidence: 99%

See 3 more Smart Citations

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Allen

Jauniaux

Hobson

et al. 2018

Intl J Gynecology & Obste

290

282

View full text Add to dashboard Cite

Safer outcomes for placenta accreta spectrum disorders: A decade of quality improvement

Hobson

Kingdom

Windrim

et al. 2021

Intl J Gynecology & Obste

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Objective To describe the evolution and evaluation of protocol‐based multidisciplinary quality improvement (QI) in women undergoing cesarean hysterectomy for radiologically suspected and pathologically confirmed placenta accreta spectrum (PAS) disorders. Methods A single‐center, retrospective cohort study was conducted of all patients undergoing cesarean hysterectomy for PAS disorders between March 2009 and June 2018. Two distinct periods were defined to compare outcomes: 2009–2011 (initial period) and 2017–2018 (current period). Primary outcomes included blood loss and administration of blood products. Secondary outcomes included perioperative levels of hemoglobin, adverse events and complications, time to mobilization, and length of hospitalization. Results Among the 105 consecutive patients identified, there were 26 in the initial period and 32 in the current period. With the implementation of all QI care bundles, median estimated surgical blood loss halved from 2000 ml in the initial period to 1000 ml in the current period, and fewer patients required allogenic blood transfusion (61.5% vs 25%). Patients in the current period demonstrated improved postoperative levels of hemoglobin compared to those in the initial period (101 g/L vs 89 g/L) and had a shorter median postoperative hospital stay (3 days vs 5 days). Conclusion These results support the implementation of a multifaceted QI and patient care initiative for women with PAS disorders.

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Placenta accreta spectrum—A single‐center retrospective observational cohort study of multidisciplinary management over time

Uddén

Carlsson

Karlsson

et al. 2022

Intl J Gynecology & Obste

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Objective To evaluate whether the results of a previous study that showed a decrease in blood loss and transfusions with a multidisciplinary approach, including a fixed team when delivering women diagnosed with placenta accreta spectrum at Sahlgrenska University Hospital, remained low throughout time, and to investigate hospital stay and maternal and neonatal complications during a time period with varying team structure compared with previous periods. Methods A retrospective observational cohort study comparing data from medical records including three cohorts of women diagnosed with placenta accreta spectrum between October 2003 and December 2020. Cohort 1 consisted of women delivered before the multidisciplinary approach was introduced. Cohort 2 and cohort 3 were both managed in a multidisciplinary manner, but while cohort 2 was managed by a fixed team, cohort 3 was managed by several different senior specialists. The data were analyzed using Kruskal‐Wallis test. Results Blood loss and need for transfusion were significantly lower for cohort 3 and cohort 2 compared with cohort 1. No significant difference was found between cohort 3 and cohort 2. Conclusion The multidisciplinary management and surgical method employed at Sahlgrenska University Hospital have lowered blood loss and the need for transfusions, even over time.

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Invasive placental disease: the impact of a multi-disciplinary team approach to management

Abstract: Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.

Cited by 46 publications

References 29 publications

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Safer outcomes for placenta accreta spectrum disorders: A decade of quality improvement

Placenta accreta spectrum—A single‐center retrospective observational cohort study of multidisciplinary management over time

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