Outcomes of Placenta Accreta Cases Managed via a Placenta Accreta Protocol Versus Without a Protocol [29N

Abstract

INTRODUCTION: Placenta accreta spectrum (PAS) is a collection of conditions of abnormal placentation that when undiagnosed at the time of delivery, can lead to massive hemorrhage, disseminated intravascular coagulopathy, hypovolemic shock, and maternal mortality. The purpose of our project was to evaluate outcomes before and after the creation and implementation of our institution's placenta accreta protocol. METHODS: After IRB approval was obtained, a retrospective chart review of all deliveries at our institution from January 1st 2007 until December 31st 2015 was performed. Cases were grouped based on those managed following our institution's placenta accreta protocol and those not managed according to the protocol. The data was analyzed using a Student T-test and Chi-Squared (X2) analysis. RESULTS: There was a statistically significant difference in outcomes between cases managed with the protocol versus without the protocol for estimated blood loss (P=0.009), units of blood transfused (P=0.002), and intensive care unit admission (P=0.001). CONCLUSION: Establishing a suspected diagnosis of PAS before delivery allows for a scheduled delivery and pre-operative planning with a multidisciplinary team based on the severity of the PAS. No randomized controlled trials exist to guide management; therefore management varies between institutions and practitioners. Our retrospective study supports ACOG Committee Opinion No. 529's conclusion in that there was a statistically significant difference in outcomes between unplanned and planned cesarean hysterectomy. As this study demonstrated a clear decrease in adverse outcomes, since this study was performed, all patients with a high suspicion for PAS have been managed using our new protocol.