Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

Zhong, Wei; Zhu, Fang; Li, Shengqiong; Chen, Jin; He, Fengya; Xiao, Jie; Yang, Mei

doi:10.3389/fmed.2021.731412

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…Infants born to women with an urgent delivery for PAS had worse clinical outcomes including lower gestational age, higher NICU admission, and perinatal mortality. This is consistent with the findings of previous research where a planned delivery for PAS with a multidisciplinary team showed favourable neonatal outcomes when compared with an urgent delivery [ 18 , 20 , 23 , 35 ]. However, it is worth noting that several studies did not find significant differences in neonatal outcomes between the two delivery groups [ 25 , 36 , 37 ].…”

Section: Discussionsupporting

confidence: 92%

“…Our results are in agreement with Morlando et al [ 18 ], which found no significant differences in transfusion rates or major morbidity between planned and emergency deliveries among women with PAS. On the contrary, a systematic review and meta-analysis of nine related studies comparing maternal outcomes for PAS patients delivering via planned and emergency procedures showed that women undergoing planned delivery required fewer units of transfused blood, experienced shorter hospital stay durations, and presented reduced risks for maternal ICU admission and severe maternal morbidity [ 20 ]. The review results may be explained by differences in levels of experience of clinicians in PAS management.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of robust evidence-based standard of care, the optimal management of PAS remains undefined [ 12 ]; however, a comprehensive care plan tailored by a multidisciplinary team in a high-resource setting can help guide early diagnosis and timely delivery [ 13 – 16 ]. Scheduled rather than urgent delivery has been shown to reduce haemorrhagic complications and thereby improve maternal as well as neonatal outcomes [ 15 , 17 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Scheduled rather than urgent delivery has been shown to reduce haemorrhagic complications and thereby improve maternal as well as neonatal outcomes [15,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Scheduled rather than urgent delivery has been shown to reduce haemorrhagic complications and thereby improve maternal as well as neonatal outcomes [15,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…It mainly explains why the ECD group has lower birth weights and worse perinatal outcomes, because gestational age at delivery is a major determinant of neonatal survival and morbidity. [36,38] In general, our findings are in line with a previous similar meta-analysis by Zhong et al, [39] which focused on the obstetrical outcomes of women with PAS, and the neonatal outcomes were limited by a small sample size of infants. The strength of the current study, on the other hand, is the larger population involved, with an emphasis on all relevant parameters that reflect perinatal condition.…”

Section: Discussionsupporting

confidence: 91%

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis

Huang

Yang

2023

Medicine

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Background: Although planned cesarean delivery (PCD) is the mainstay of management for abnormal placentation, some patients still require emergency cesarean delivery (ECD). We aimed to systematically analyze the impact of various modes of delivery on neonatal outcomes. Methods: This study was complied with the PRISMA guidelines and was registered in the PROSPERO (code: CRD42022379487). A systematic search was conducted on Ovid MEDLINE and Embase, Web of Science, PubMed, and the Cochrane databases. Data extracted included gestational age at delivery, birth weight, the Apgar scores at 1 and 5 minutes, numbers of newborns with low Apgar score (<7) at 5 minutes, the rates of neonatal intensive care unit admission, and the rates of neonatal mortality. Results: Fifteen cohort studies met the inclusion criteria, comprising a total of 2565 women (2567 neonates) who underwent PCD (n = 1483) or ECD (n = 1082) for prenatally diagnosed placenta accreta spectrum (PAS) and/or placenta previa (PP). Compared with the ECD group, neonates in the PCD group had significantly higher gestational ages (standardized mean difference [SMD]: 2.20; 95% confidence interval [CI]: 1.25–3.15; P < .001), birth weights (SMD: 1.64; 95% CI: 1.00–2.27; P < .001), and Apgar scores at 1 minute (SMD: 0.51; 95% CI: 0.29–0.73; P < .001) and 5 minutes (SMD: 0.47; 95% CI: 0.25–0.70; P < .001). Additionally, the PCD group had significantly lower rates of neonatal intensive care unit admission (odds ratio [OR]: 0.21; 95% CI: 0.14–0.29; P < .001), low Apgar score at 5 minutes (OR: 0.27; 95% CI: 0.11–0.69; P = .01), and neonatal mortality (OR: 0.13; 95% CI: 0.05–0.33; P < .001). Conclusion: When pregnancies are complicated by abnormal placentation, PCD is linked to noticeably better neonatal outcomes than emergent delivery.

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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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Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 32 publications

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

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

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis

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

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