Assessing the multidisciplinary team approaches to placenta accreta spectrum across five institutions within the University of California fetal Consortium (UCfC)

To describe the multidisciplinary approaches to placenta accreta spectrum (PAS) across five tertiary care centers that comprise the University of California fetal Consortium (UCfC) and to identify potential best practices. Retrospective review of all cases of pathologically confirmed invasive placen...

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Bibliographic Details
Published in:The journal of maternal-fetal & neonatal medicine 2021-09, Vol.34 (18), p.2971-2976
Main Authors: Fratto, Victoria M., Conturie, Charlotte L., Ballas, Jerasimos, Pettit, Kate E., Stephenson, Megan L., Truong, Yen N., Henry, Dana, Afshar, Yalda, Murphy, Aisling, Kim, Lena, Field, Nancy, Wing, Deborah A., Norton, Mary E., Ramos, Gladys A.
Format: Article
Language:English
Subjects:
Female
Humans
Hysterectomy
Intravascular balloons
multidisciplinary approach
Patient Care Team
Placenta Accreta - surgery
placenta accreta spectrum
placenta increta
placenta percreta
Pregnancy
Prenatal Care
Retrospective Studies
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Summary:To describe the multidisciplinary approaches to placenta accreta spectrum (PAS) across five tertiary care centers that comprise the University of California fetal Consortium (UCfC) and to identify potential best practices. Retrospective review of all cases of pathologically confirmed invasive placenta delivered from 2009 to 2014 at UCfC. Differences in intraoperative management and outcomes based on prenatal suspicion were compared. Interventions assessed included ureteral stent use, intravascular balloon use, anesthetic type, gynecologic oncology (Gyn Onc) involvement, and cell saver use. Intervention variation by institution was also assessed. Analyses were adjusted for final pathologic diagnosis. Chi-square, Fisher's exact, Student's t-test, and Mann-Whitney's U-test were used as appropriate. Binary logistic regression and multivariable linear regression were used to adjust for confounders. One hundred and fifty-one cases of pathologically confirmed invasive placenta were identified, of which 82% (123) were suspected prenatally. There was no correlation between the degree of invasion on prenatal imaging and use of each intervention. Ureteral stents were placed in 33% (41) of cases and did not reduce GU injury. Intravascular balloons were placed in 29% (36) of cases and were associated with shorter OR time (161 versus 236 min, p
ISSN:1476-7058
1476-4954
DOI:10.1080/14767058.2019.1676411