Risk of Severe Maternal Morbidity (SMM) in patients with Placenta Accreta Spectrum (PAS) disorders referred from rural communities to a regional PAS center.

Abstract

The primary objective of this study was to assess the risk of Severe Maternal Morbidity (SMM) experienced by patients residing in rural communities when delivered by a multidisciplinary team within a single urban academic center for Placenta Accreta Spectrum (PAS). Subsequently, we aimed to determine a distance dependent relationship between PAS morbidity and distance travelled by patients in rural communities. This was a retrospective cohort study of patients who had PAS histopathologic confirmation and delivery at our institution from 2005-2022. Our objective was to determine the relationship between patient locations (rural vs. urban) and maternal morbidity associated with PAS delivery. Socio-geographic determination of rurality was determined using the National Center for Health Statistics and most recent national census population data. Distance travelled was calculated by patient zip code to our PAS center using global positioning system data. During the study period, 139 patients were managed by cesarean hysterectomy with confirmed PAS histopathology. Of these, ninety-four (67.6%) were from our urban community and forty-five (32.4%) were from surrounding rural communities. The overall SMM incidence was 85% including blood transfusion and 17% without blood transfusions. Patient from rural communities were more likely to experience SMM (28.9% vs. 12.8%, p=0.03) and this was driven by acute renal failure (1.1 vs 11.1%, p=0.01) and disseminated intravascular coagulopathy (1.1 vs 8.8%, p=0.04). SMM did reveal a a distance-dependent relationship with SMM rates of 13.2%, 33.3%, and 43.8% at 50, 100 and 150 miles, respectively (p=0.005). Patients with PAS experience high rates of SMM. Geographic distance to a PAS center appears to significantly impact the overall morbidity a patient experiences. Further research is warranted to address this disparity and optimize patient outcomes for patients in rural communities.