586: Planned versus Unplanned delivery for patients with placenta accreta spectrum

Abstract

Women with placenta accreta spectrum (PAS) requiring unplanned delivery may have a worse outcome compared to women with a planned delivery. The aims of our study was to assess factors associated with a need for unplanned delivery and describe maternal and perinatal outcomes following delivery in women with PAS. We conducted a retrospective cohort study at two tertiary centers (January 2009- June 2019) of all women that underwent a hysterectomy with a histologic proven PAS. The primary outcome was severe PAS defined as need for transfusion of ≥ 4 RBC units or ureter/bowel injury. Maternal demographic, clinical and sonographic characteristics were compared between the two groups. Parameteric and non-parametric statistic were used for as appropriate, Statistical significance was established if the associated p-value was < 0.05. Of 109 patients that underwent cesarean hysterectomy for PAS, 41(37.6%) had an unplanned delivery. There was no significant difference in the number of previous caesarean deliveries or ultrasound findings between the groups. Women that required an urgent delivery were more likely to bleed during pregnancy compared to those that had a planned delivery (P=0.035) (Table 1). Patients that underwent an unplanned delivery delivered on average 3 weeks earlier (30.3 vs 33.8, p=0.001), had a higher rate of the primary outcome (63% vs 36%, P=0.006) and required a higher number of RBC transfusion (5.0 vs 2.0, P=0.003) compared to patients with a planned delivery (Table 2). In our cohort, almost 40% of patients with PAS required unplanned delivery prior to 34 weeks. Unplanned delivery, even managed by experienced accreta team at a tertiary center is still associated with significant maternal morbidity. In patients with suspected PAS, there is a need to further assess, the need for an earlier delivery in order to plan timing of delivery in PAS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)