Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum: A multinational database study

Abstract

Introduction: Placenta accreta spectrum (PAS) is a condition often resulting in severe maternal morbidity. Scheduled delivery by an experienced team has been shown to improve maternal outcomes; however, the benefits must be weighed against the risk of iatrogenic prematurity. The aim of this study is to investigate the rates of emergency delivery seen for antenatally suspected PAS and compare the resulting outcomes in the 15 referral centers of the International Society for PAS (IS-PAS). Material and methods: Fifteen centers provided cases between 2008 and 2019. The women included were divided into two groups according to whether they had a planned or an emergency cesarean delivery. Delivery was defined as "planned" when performed at a time and date to suit the team. All the remaining cases were classified as "emergency". Maternal characteristics and neonatal outcomes were compared between the two groups according to gestation at delivery. Results: In all, 356 women were included. Of these, 239 (67%) underwent a planned delivery and 117 (33%) an emergency delivery. Vaginal bleeding was the indication for emergency delivery in 41 of the 117 women (41%). There were no significant differences in terms of blood loss, transfusion rates or major maternal morbidity between planned and emergency deliveries. However, the rate of maternal intensive therapy unit admission was increased with emergency delivery (45% vs 33%, P = .02). Antepartum hemorrhage

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

“…The average blood loss during PAS surgery has been reported as varying between 2000 and 5000 mL, levels which require in turn massive blood transfusion [13,16,33,34]. PAS also involves increased rates of organ injuries and ICU admissions and longer hospital stays, as found in our study and other studies [11,13,35,36]. Our study was done in the main tertiary referral center for managing PAS in the south of Thailand, where the incidence of PAS has been increasing for several years now and recently reported the very high rate of 1:161 deliveries [10].…”

“…Our study was done in the main tertiary referral center for managing PAS in the south of Thailand, where the incidence of PAS has been increasing for several years now and recently reported the very high rate of 1:161 deliveries [10]. The average blood loss in PAS during the study period was 2500 mL, which is in the same range as other studies [34][35][36][37]. In our study, most of the PAS cases underwent a cesarean hysterectomy (94%)…”

Emergent versus planned delivery in patients with placenta accreta spectrum disorders

“…According to the study by Morlando et al, delivery at >36 weeks’ gestation in women who have not bled and have no risk factors for preterm birth could be considered. [ 32 ] In another study by Robinson and Grobman, delivery at 37 weeks of gestation was the preferred strategy in limited situations, and delivery at 39 weeks of gestation was considered only in unlikely situations. [ 33 ] According to the management strategy of PAS disorders in our hospital, the time of planned cesarean section is ranged between 36 and 37 weeks.…”

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

“…Seventeen studies were reviewed in detail, with nine meeting inclusion criteria (Table 1) (17)(18)(19)(20)(21)(22)(23)(24)(25). Three of these nine were conducted in the USA, two in China, one each in Lebanon, Argentina, and Israel, and one was multicentric.…”