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Maternal and Fetal Outcomes in Placenta Accreta After Institution of Team-Managed Care

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Abstract

Introduction

Placenta accreta significantly contributes to maternal morbidity and mortality. We evaluated whether planned delivery and experienced, team-managed surgical intervention results in improved outcomes. We also examined whether risk factors differed for accreta, increta, and percreta and evaluated whether excess lower segment uterine vascularity correlates with disease severity.

Methods

We retrospectively analyzed patients before versus after institution of a management protocol. Of the 58 044 deliveries over 10 years, there were 67 women whose pregnancies were histopathologically confirmed as placenta accreta, increta, or percreta (1/866). Clinical outcome measures were estimated blood loss (EBL), packed red blood cells (pRBCs) transfused, maternal and fetal complications, intensive care unit admission, and length of stay.

Results

There were no maternal or infant deaths. In the managed cohort, EBL was reduced by 48% (P < .001), intraoperative pRBCs transfused by 40% (P < .01), total transfused pRBCs per case by 50% (P < .01), and surgical intensive care unit admissions by >50% (P < .01). Assessment of maternal risk factors by diagnosis revealed marked differences between accreta versus increta and percreta. Clinically assessed excess vascularity of the lower uterine segment correlated with disease severity. The incidence of neonatal complications was similar in both cohorts.

Conclusions

Targeted delivery at 34 weeks and team-managed diagnosis, treatment, and care of patients with placenta accreta were associated with improved maternal, but not neonatal outcomes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Hackensack University Medical Center, Hackensack, NJ, USA

    Abdulla Al-Khan MD, Vivek Gupta MD, Nicholas P. Illsley DPhil, Manuel Alvarez MD & Stacy Zamudio PhD

  2. Center for Abnormal Placentation, Hackensack University Medical Center, Hackensack, NJ, USA

    Abdulla Al-Khan MD, Vivek Gupta MD, Nicholas P. Illsley DPhil, Ciaran Mannion MD, Christopher Koenig MD, Adam Bogomol MD, Manuel Alvarez MD & Stacy Zamudio PhD

  3. Department of Pathology, Hackensack University Medical Center, Hackensack, NJ, USA

    Ciaran Mannion MD & Christopher Koenig MD

  4. Department of Radiology, Hackensack University Medical Center, Hackensack, NJ, USA

    Adam Bogomol MD

  5. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Center for Abnormal Placentation, 30 Prospect Ave. WCP 4E-90G, Hackensack, NJ, 07601, USA

    Abdulla Al-Khan MD

Authors
  1. Abdulla Al-Khan MD
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  2. Vivek Gupta MD
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  3. Nicholas P. Illsley DPhil
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Correspondence to Abdulla Al-Khan MD.

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Al-Khan, A., Gupta, V., Illsley, N.P. et al. Maternal and Fetal Outcomes in Placenta Accreta After Institution of Team-Managed Care. Reprod. Sci. 21, 761–771 (2014). https://doi.org/10.1177/1933719113512528

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