Placenta accreta spectrum: We can do better.

Abstract

Placenta accreta spectrum (PAS) has a high risk of maternal morbidity, and requires meticulous antenatal and peripartum management. To compare the management and outcomes of PAS between women with and without antenatally suspected disease, and to evaluate the effect of multidisciplinary team (MDT) management. A retrospective cohort study identified all hysterectomy specimens with a histopathological diagnosis of PAS in the Western Sydney Local Health District between January 2006 and December 2019, and analysed each patient's clinical course. Seventy patients had PAS diagnosed on hysterectomy specimens, of which 38 cases (54%) were antenatally suspected. Women with suspected PAS were more likely to have a previous caesarean section (100% vs 68%, P<0.001), placenta praevia (92% vs 56%, P<0.001) and anterior placenta (95% vs 66%. P=0.011). Suspected PAS was associated with less maternal blood loss (median blood loss 2000mL vs 4000mL, P<0.001), fewer red blood cell transfusions (median four units vs nine units, P<0.001), and shorter intensive care or high dependency unit admission (mean stay one day vs three days, P=0.037). There were no significant differences in other maternal morbidities. MDT management was associated with a clinically significant reduction in maternal blood loss (1500mL vs 2520mL, P=0.09) and red blood cell transfusion (one unit vs six units, P=0.04). The mean gestation of delivery was 37weeks in both groups with no differences in neonatal morbidity. Both antenatally diagnosed PAS and MDT management reduced blood loss and blood transfusion. Elective delivery at 37weeks gestation reduces the neonatal risks of preterm delivery.