128 Fellowship exposure to management strategies for placenta accreta spectrum

Abstract

To determine exposure of Maternal-Fetal Medicine (MFM) and Gynecologic Oncology (GO) fellows to alternative management strategies for placenta accreta spectrum (PAS) across the United States. A REDCap survey was sent by email to program directors (PD) of all ABOG-approved MFM and GO fellowships. Responses were anonymous unless participants elected to include contact information. From returned surveys we collected demographic information, including program location, fellowship type, and protocol for managing PAS. Clinical questions about multidisciplinary team involvement, surgical approaches, and considerations for PAS were included. Descriptive statistics were performed. Surveys were emailed to PD at 85 MFM and 61 GO programs . We received 69 complete responses representing 45 MFM (65%) and 24 GO (35%) programs from all regions of the United States (Table 1). All PD reported that fellows have an inpatient role. Most indicated that multidisciplinary team involvement occurs for suspected PAS (99%), with Anesthesiology, Urology, OB/GYN Specialist, Radiology, and Transfusion Medicine being the most common collaborating services. Overall, 27 (39%) PD indicated that their practice offers alternative strategies for management of PAS. This includes 20 (29%) who perform delayed hysterectomy and 7 (12%) who offer a conservative strategy of expectant management rather than hysterectomy. The majority of programs perform immediate hysterectomy for all PAS cases (40, 57%). Regional variation was noted with programs on the east coast more likely to offer alternative management strategies. Clinical approaches to PAS differ across the United States with regional variation. MFM and GO fellows are involved in the care of these patients, but their clinical exposure to various management strategies depends on training institution, and over 40% will likely not gain exposure to alternative strategies such as conservative management or delayed hysterectomy during fellowship.