VP46.07: Centre of excellence for placenta accreta spectrum: surgical and maternal outcome

Abstract

We build our multidisciplinary team for management of placenta accreta spectrum (PAS) and we are presenting our experience and outcome. This is a prospective cohort study done between April 2018 and March 2019. All women with radiological evidence of PAS and confirmed intraoperatively were included in the study and treated by the same team. All elective cases were booked for Caesarean hysterectomy or conservative surgery between 34–36 weeks. Same surgical technique was applied in all cases. Our standard surgical approach consists of lithotomy position under general anesthesia, a midline laparotomy, adhesiolysis, classical uterine incision, bilateral internal iliac artery ligation, en-bloc hysterectomy with placenta in-situ (figure 1). For conservative surgery: bilateral internal iliac artery ligation, removing the placenta, resection and repair of the defective uterine wall and bilateral salpingectomy. A total of 75 cases of PAS were referred to our centre and managed by the same team. 72% of cases were done electively. The mean maternal age was 36 years.The median number of Caesarean scars was 3. At time of surgery, 85% of cases were at 34 weeks. Overall intraoperative complication rate was 26.7%, bladder injury (17.3%), ureteric injury (4%), vascular injury (2.7%), massive bleeding and DIC (8%), maternal mortality (2.7%). Postoperatively 12% shifted to ICU under ventilation support. The median postoperative in hospital stay was 5 days. The median blood loss was 3,300ml. The median blood product transfused was 6 units of PRBC, FFP, platelets and 11 units of cryoprecipitate. Multidisciplinary team management for PAS with prespecified protocol for women care can improve the surgical and maternal outcomes. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.