Placenta Accreta Spectrum: The Effect of Establishing a Systematic Program for Diagnosis and Management [27M

Abstract

INTRODUCTION: Improvements in management of placenta accreta spectrum (PAS) can reduce maternal morbidity and mortality. Our objective was to determine the effect on outcomes following the introduction of a systematic program for diagnosis and management of PAS at our institution. METHODS: This was a retrospective cohort study of deliveries complicated by PAS at New York Presbyterian Queens (NYPQ) from November 2011 to July 2019. NYPQ implemented a systematic program for diagnosis and management of PAS in January 2015. The program included an emphasis on antenatal diagnosis, required scans for all repeat cesarean deliveries and multidisciplinary team management. Group 1 is designated as before and Group 2 is after establishment of the program. A composite outcome which included unplanned hysterectomy, ICU admission, return to the operating room or transfusion of ≥4 units of blood) was also examined. Chi square and Mann Whitney U tests were used in statistical analysis. IRB approval was obtained. RESULTS: Of 124 cases eligible cases, 35 (28%) had confirmed PAS (6 cases in Group 1, 29 cases in Group 2). The two groups were similar in terms of maternal age, parity, BMI and number of prior cesarean deliveries. There was no difference in composite morbidity between Groups 1 and 2 (66.7% vs 48.3%, P=.42). There was a trend toward improvement in unplanned hysterectomy and blood transfusion in Group 2. CONCLUSION: The establishment of our accreta program allowed us to demonstrate improvement in several outcome measures that did not achieve statistical significance due to small numbers.