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Maternal morbidity in placenta accreta spectrum following introduction of a multi-disciplinary service compared to standard care: an Irish perspective

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Abstract

Aim

The purpose of this study is to compare maternal outcomes in patients with placenta accreta spectrum (PAS) when managed as part of a multi-disciplinary team (MDT) compared to standard care.

Methods

Patients in the standard care group were retrospectively identified from pathology records, with patients in the MDT group prospectively collected on an electronic database. Data on maternal demographics, delivery, estimated blood loss (EBL), transfusion requirements, and morbidity were recorded.

Results

Sixty patients were diagnosed with PAS between 2006 and 2019, of whom 32 were part of the standard care group and 28 in the MDT group. Compared to standard care, MDT care was associated with an increase in antenatal diagnosis from 56.3 to 92.9% (p < 0.0001), a significant reduction in EBL (4150 mL (800–19500) vs 1975 (495–8500), p < 0.0001), and transfusion requirements (median 7 (0–30) units of RCC vs 1 (0-13), p < 0.0001).

Conclusion

PAS is associated with significant maternal morbidity and warrants management in an MDT setting with specialist input, which is associated with improved outcomes.

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Abbreviations

PAS:

Placenta accreta spectrum

MDT:

Multidisciplinary team

EBL:

Estimated blood loss

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Author information

Authors and Affiliations

  1. National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Helena C. Bartels, Karen M. Mulligan, Simon Craven, Shane Higgins, Donal J. O’Brien, Ruaidhri McVey, Peter McParland, Jennifer M. Walsh, Stephen Carroll, Siobhan Corcoran, Mike Robson, Rhona Mahony, Paul Downey, David Brophy, Gabrielle Colleran, Fionnuala M. McAuliffe & Donal J. Brennan

  2. Department of Surgery, Mater Misericordiae University Hospital, Dublin, 7, Ireland

    Ailin C. Rogers

  3. Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Fionnuala M. McAuliffe & Donal J. Brennan

Authors
  1. Helena C. Bartels
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  2. Karen M. Mulligan
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  3. Simon Craven
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  4. Ailin C. Rogers
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  5. Shane Higgins
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  6. Donal J. O’Brien
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  7. Ruaidhri McVey
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  8. Peter McParland
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  9. Jennifer M. Walsh
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  10. Stephen Carroll
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  11. Siobhan Corcoran
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  12. Mike Robson
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  13. Rhona Mahony
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  14. Paul Downey
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  15. David Brophy
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  16. Gabrielle Colleran
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  17. Fionnuala M. McAuliffe
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  18. Donal J. Brennan
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Corresponding author

Correspondence to Donal J. Brennan.

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The authors declare that they have no conflict of interest. All authors who contributed to the manuscript are named authors.

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Key message

Maternal outcomes are significantly improved in placenta accreta spectrum when managed by a multidisciplinary team in a specialist center. Antenatal diagnosis, elective pre-term delivery, and a standardized surgical approach contribute to improved maternal outcomes.

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Bartels, H.C., Mulligan, K.M., Craven, S. et al. Maternal morbidity in placenta accreta spectrum following introduction of a multi-disciplinary service compared to standard care: an Irish perspective. Ir J Med Sci 190, 1451–1457 (2021). https://doi.org/10.1007/s11845-020-02473-3

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  • DOI: https://doi.org/10.1007/s11845-020-02473-3

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