103: Treatment of placenta accreta spectrum (PAS) utilizing a standardized multidisciplinary approach: The Obstetrics-Trauma Team

Abstract

To describe the impact of implementing an obstetrics-trauma multidisciplinary surgical team on Placenta Accreta Syndrome (PAS) outcomes among patients seen at a high-risk Maternal Care Facility and Level I Trauma Center within a safety net community hospital in Florida. A retrospective chart review of patients, between the ages of 22 and 43 years old, with a confirmed diagnosis of PAS who were seen between the years 2013 and 2019 was conducted. Blood transfusion, hospital readmission within 6 weeks, maternal and fetal survival, estimated blood loss and common risk factors were examined pre- and post-implementation. Twenty-one patients were included in this study; ten in the pre-period and eleven in the post-period. The average maternal age at birth was 32 and 35 years old in the pre and post period, respectively. All patients in the pre-period had a history of cesarean section (CS) compared to 82% in the post-period. The average number of prior CS was similar between the two periods (mean=2). When examining outcome measures, results showed that after implementation of the multidisciplinary team approach, a reduction in the proportion of blood transfusions were observed (63.6% vs. 77.8%; p=0.64). There was also a reduction in estimated blood loss (-2212.7; p=0.14). In terms of survival, maternal survival increased from 90% in the pre-period to 100% in the post-period (p=0.48), and fetal survival remained at 100%. PAS-related critical illness shares several similarities to the care of trauma patients. In the setting of a community hospital where Gynecologic Oncology or surgically trained Maternal Fetal Medicine physicians are not available, Trauma surgeons involvement can be vital in reducing morbidity and mortality in a team setting. Results of our study suggest the benefit of a multidisciplinary surgical team in a PAS program. Incorporation of the multidisciplinary team may prove beneficial for centers dedicated to caring for these high risk deliveries in a community setting; however, further research is warranted.