Impact of a standardized multidisciplinary protocol for placenta accreta spectrum on blood bank services

Abstract

To assess the impact of a standardized multidisciplinary protocol for managing patients with placenta accreta spectrum (PAS) on the utilization of blood bank services. We performed a retrospective cohort study of all pregnant women managed at our center between January 2013 and October 2019 for confirmed or suspected PAS disorders. We compared the demographic and clinical characteristics of the patients and the utilization of blood bank services, including dispensed, transfused, and wasted blood components products, before (T1) and after (T2) the implementation of a standardized multidisciplinary protocol. This protocol focused on increased surveillance and readiness for patients at risk for PAS, standardization of surgery, anesthesia and transfusion practices, selective embolization of pelvic arteries in patients with abnormally invasive placenta, intraoperative blood salvage, and robust treatment of anemia antenatally. Univariate analysis was performed using unpaired t, Mann-Whitney, chi-square, and Fisher's exact tests as appropriate. The patients' characteristics in T1 and T2 were comparable (Table1). In T2, 79% of the patients were managed according to the protocol. The number of blood products dispensed from the blood bank, particularly RBCs, increased during T2. (Table 2). In contrast, fewer RBCs and FFPs were transfused in T2. There was no significant difference in dispensed or transfused platelet and cryoprecipitate units. The number of wasted blood products was small and did not significantly change. The decreased transfusion of RBC and FFP was the result of a decline in peripartum blood loss (median, 800 vs.1550 ml, p< . 001) and the risk for massive blood loss (RR: 0.16, 95% CI: 0.03 to 0.92, p=.04) and stage 3 postpartum hemorrhage (RR: 0.37, 95% CI: 0.17 to 0.75, p=.009). The standardized multidisciplinary protocol for PAS increased the workload of our blood bank due to greater dispensation of blood products but resulted in fewer RBC and FFP transfusions parallel to a decline in catastrophic hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)