Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean‐hysterectomy within a multidisciplinary care team

Flores-Mendoza, H; Chandran, Anjana; Hernández-Nieto, Carlos; Murji, A.; Allen, Lisa; Windrim, Rory; Kingdom, John; Hobson, Sebastian

doi:10.1002/ijgo.14121

Cited by 20 publications

(18 citation statements)

References 48 publications

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“…Preterm birth is the common risk factor for perinatal morbidity and mortality shared by the majority of infants born via either approach of delivery in the context of abnormal placentation. [16–18,21–23,25–28,33] In our study, the gestational age at delivery was significantly lower in neonates born emergently compared to those with planned approaches. 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.…”

Section: Discussionmentioning

confidence: 67%

“…Nine studies reported the means of gestational age at delivery in the PCD and ECD gro ups. [18][19][20][21][22]24,25,27,33] The overall pooled estimate for gestational age was significantly higher in the PCD group compared to the ECD group (SMD: 2.20; 95% CI: 1.25-3.15; P < .001; I 2 = 98%). This finding was also seen in the subgroups of women with PP alone (SMD: 1.29; 95% CI: 1.02-1.56; P < .001; I 2 = 22%) and PAS patients with or without coexistent PP (SMD: 2.51; 95% CI: 1.21-3.81; P < .001; I 2 = 98%) (Fig.…”

Section: Quantitative Analysesmentioning

confidence: 99%

“…Thirteen studies compared the birth weights between the PCD and ECD groups. [16][17][18][19][20][21][22][23][24][25]27,28,33] However, one study [16] reported the medians of birth weight in 3 gestational ranges and therefore could not be pooled. In comparison to the ECD group, the pooled birth weight was significantly higher in the PCD group (SMD: 1.64; 95% CI: 1.00-2.27; P < .001; I 2 = 97%).…”

Section: Neonatal Birth Weightmentioning

confidence: 99%

“…Accumulating data has suggested that ECD is associated with a higher risk of adverse maternal outcomes compared to PCD, including more profound intraoperative blood loss, increased need for blood transfusion and intensive care unit admission, and a longer hospital stay. [17][18][19][20][21][22][23][24][25][26][27][28] Regardless, a recent multicenter study found that less than half of prenatally diagnosed PAS patients (39%) in the United States reached a scheduled delivery within the recommended gestational age. [29] As a result, ECD remains an unavoidable and yet common practice for women with abnormal placentation, and understanding the differences between ECD and PCD is critical for optimizing maternal-fetal care.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 67%

Section: Quantitative Analysesmentioning

confidence: 99%

Section: Neonatal Birth Weightmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…There will, however, be some cases in which diagnoses are missed or are emergently managed with or without the presence of an experienced team. In such cases, outcomes have been shown to be poorer, highlighting the importance of optimizing diagnosis, pre-operative planning, and multidisciplinary care 21…”

Section: Multidisciplinary Management and Pre-operative Planningmentioning

confidence: 99%

Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists

Touhami

Allen

Mendoza

et al. 2022

Int J Gynecol Cancer

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Placenta accreta spectrum disorders are a major risk factor for severe postpartum hemorrhage and maternal death worldwide, with a rapidly growing incidence in recent decades due to increasing rates of cesarean section. Placenta accreta spectrum disorders represent a complex surgical challenge, with the primary concern of massive obstetrical hemorrhagic sequelae and organ damage, occurring in the context of potentially significant anatomical and physiological changes of pregnancy. Most international obstetrical organizations have published guidelines on placenta accreta spectrum, embracing the creation of regionalized ‘Centers of Excellence’ in the diagnosis and management of placenta accreta spectrum, which includes a dedicated multidisciplinary surgical team. One mandatory criterion for these Centers of Excellence is the presence of a surgeon experienced in complex pelvic surgeries. Indeed, many institutions in the United States and worldwide rely on gynecologic oncologists in the surgical management of placenta accreta spectrum due to their experience and skills in complex pelvic surgery. Surgical management of placenta accreta spectrum frequently includes challenging pelvic dissection in regions with distortion of anatomy alongside large aberrant neovascularization. With a goal of definitive management through cesarean hysterectomy, surgeons require a systematic and thoughtful approach to promote prevention of urologic injuries, embrace measures to secure challenging hemostasis and, in selected cases, employ conservative management where indicated or desired. In this review recommendations are made for gynecologic oncologists regarding the management and important considerations in the successful care of placenta accreta spectrum disorders. Where required, gynecologic oncologists are encouraged to be proactively involved in the management of placenta accreta spectrum, not only intra-operatively, but also in the development of clinical protocols, guidelines, and pre-operative counseling of patients, as a ‘call if needed’ approach is suboptimal for this potentially major and life-threatening condition.

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Successful multidisciplinary team management of placenta accreta spectrum disorder: A referral center model in a middle‐income country

Muadtongon,

Rattanaburi,

Ajimakul

et al. 2024

Intl J Gynecology & Obste

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ObjectiveThe aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand.MethodsThis retrospective single‐center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016.ResultsOf 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001).ConclusionThe incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle‐income country setting.

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Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean‐hysterectomy within a multidisciplinary care team

Cited by 20 publications

References 48 publications

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

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

Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists

Successful multidisciplinary team management of placenta accreta spectrum disorder: A referral center model in a middle‐income country

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