Outcomes of Evidence-Based Stratification of Placenta Accreta Spectrum (PAS) Disorders for Team-Based Management [ID: 1375468

Abstract

INTRODUCTION: Placenta accreta spectrum (PAS) is characterized by placental invasion and adherence to underlying uterine myometrium resulting in significant maternal morbidity and mortality. Despite knowledge that greater placental depth results in worse outcomes, many centers approach PAS with a single uniform management protocol. We aimed to undercover the effect of surgical planning stratification by antenatal suspicion of placental depth. METHODS: This study was a preimplementation and postimplementation of analysis of PAS surgical stratification by suspected depth of placental invasion, accreta (less invasion) or increta/percreta (greater invasion), from 2019 to 2022. Depth of placenta invasion was determined by ultrasonography and/or magnetic resonance imaging. As a control, 4-year (2015–2018) preimplementation group was used to assess the effect of the protocol. This protocol included utilization of a hybrid operating room, uniform uterine artery embolization, as well as staffing by advanced pelvic surgeons. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. Exclusion criteria included pregnancy less than 20 weeks of gestation, fetal demise, and multifetal gestation. RESULTS: During the 8-year time period, a total of 93 patients were managed by our PAS team. Forty-six patients were in the preimplementation period, of which 17 (37%) were suspected increta/percreta. During the postimplementation period, 24 of 53 (45%) cases were suspected increta/percreta. In cases of placenta accreta, no significant differences were noted in blood loss, blood transfusion rates, or operative time. When analyzing outcomes of the suspected increta/percreta cohort, our protocol was associated with lower blood loss (2,500 versus 1,500 mL, P=.008), lower blood transfusion rates (88% versus 54%, P=.03), and longer operative time (240 versus 384 minutes, P=.009). Final pathology confirmed increta/percreta suspicion in 23 of the 24 cases (96%). CONCLUSION: A protocol for the management of PAS cases by antenatally suspected degree of placenta invasion is not only feasible but results in optimal outcomes for patients with the most complex obstetric conditions.