Multidisciplinary Approach to Reduce the Risk of Morbidity and Mortality Related to Placenta Accreta

Abstract

Poster Presentation Background Placenta previa and accreta can be life threatening and have a high risk of morbidity for mother and infant. The incidence of placenta accreta has increased significantly during the last 30 years. Multidisciplinary planning may reduce the risk of maternal and neonatal morbidity and mortality. The American College of Obstetricians and Gynecologists recommended a planned preterm cesarean hysterectomy with the placenta left in situ. Case A 36‐year‐old, G3P1 woman at 32 weeks gestation was admitted to the antepartum unit with a diagnosis of complete placenta previa and placenta accreta. A multidisciplinary approach was used to plan for a scheduled cesarean with hysterectomy. Multidisciplinary meetings were used to prepare staff for potential complications. The woman was transferred to labor and delivery (L&D) at 36 3/7 weeks gestation. The woman was taken to the operating room (OR) where she received an epidural and had ureteral stents placed per urology. She was then transferred to interventional radiology where arterial balloons were placed. The woman was transferred back to L&D OR for delivery accompanied by the radiologist who prepared to inflate the balloons as needed. The blood bank prepared for the case with four units of blood in the OR and 14 units on hold. After the woman was placed under general anesthesia and the neonatal team was present, the OR team proceeded with the cesarean. A viable infant was born with Apgar scores of 3, 6, 9, and weight of 2520 grams. The placenta was left in situ and the hysterectomy was completed. The woman received 500 ml of albumin and two units of packed red blood cells. The estimated blood loss was 750 ml. The woman had an uneventful recovery and was discharged three days later. Conclusion Although it is not always possible to prepare for an emergent patient who presents to the L&D unit with an acute bleeding episode due to an abnormal placentation, the admission of this woman to the antepartum unit at 32 weeks gestation and multidisciplinary planning ensured that the woman and infant had safe passage. It is essential that all providers be aware of the potential complications and the potential interventions. It is imperative that preparation for massive transfusion is in place and that all necessary equipment is available.