169: Unexpected Placenta Accreta Spectrum (PAS): Improved outcomes with Multidisciplinary Team Care

Abstract

In a 2015 Maternal-Fetal Medicine Units (MFMU) Network study, only half of Placenta Accreta Spectrum (PAS) cases were suspected before delivery and their outcomes were poorer than unanticipated cases, possibly because antenatally suspected cases were of greater severity (Bailit et al, 2015). We sought to compare the outcomes of expected (ePAS) vs unexpected PAS (uPAS) in a large U.S. center. Retrospective cohort of all histology-proven PAS deliveries in an academic referral center between January 1, 2000 and June 30, 2018; Patients only diagnosed at delivery were cases (uPAS), those antentally diagnosed were controls (ePAS.). Demographics, clinical characteristics and outcomes were analyzed using appropriate statistical methods (Table). Primary outcomes were: estimated blood loss (EBL) > 2L, and need for red blood cell (RBC) transfusion. Since we previously (2010) demonstrated our Multidisciplinary Approach (Multi-D) to improve maternal outcomes in our cohort, we adjusted for Multi-D in the analysis of the association between the primary outcomes and unexpected PAS (Logistic Regression). There were 72/268 (26.9%) patients in the uPAS group. Table 1 shows the characteristics and outcomes. Placenta previa and previous cesarean delivery (CD) were more common in the ePAS group. The median number of prior CD’s was 2 [0-6] in ePAS and 1 [0-5] in the uPAS group (P<0.001). There was a higher proportion of increta/ percreta in ePAS vs. uPAS [128 (65.3%) vs. 17 (23.6%), P<0.001]. More patients in the ePAS group underwent Multi-D [177 (90.3%) vs. 35(48.6%), P<0.001]. EBL > 2L and PRBC transfusion were more common in the uPAS than ePAS group (Table) but after adjusting for a Multi-D approach, this difference disappeared. (Table 2-Model b) Our data contradict the MFMU results, and instead show better outcomes in the expected PAS group, despite a high proportion of women with more severe placental invasion. We attribute this to our Multidisciplinary approach and ongoing process improvement. Our data underline the benefits for patients with PAS of delivering in a PAS center with a Multi-D approach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)