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Multicenter Study
. 2025 Apr 7;25(1):401.
doi: 10.1186/s12884-025-07271-2.

Management and outcomes of women with placenta accreta spectrum grade 3: an INOSS multicountry multiperiod population-based study

Anne Pinton  1   2 , Sara Ornaghi  3   4 , Marian Knight  5 , Loïc Sentilhes  6 , Serena Donati  7 , Gilles Kayem #  8   9 , Catherine Deneux-Tharaux #  8
Affiliations
Multicenter Study

Management and outcomes of women with placenta accreta spectrum grade 3: an INOSS multicountry multiperiod population-based study

Anne Pinton et al. BMC Pregnancy Childbirth. .

Abstract

Background: Management and outcomes in women with placenta accreta spectrum grade 3 are rarely reported from population-based studies. The objective of this study is to describe profiles, management, and outcomes, of women with placenta accreta spectrum (PAS) grade 3 from three multiperiod studies.

Methods: This analysis used data from three multiperiod population-based cohort studies from the United Kingdom (UK) (May 2010-April 2011), France (November 2013-October 2015), and Italy (September 2014-August 2016) to compare the management and outcomes of women with grade 3 PAS. The main outcome measures were postpartum hemorrhage (PPH) ≥ 3000 mL, blood transfusion ≥ 4 units, and other severe maternal complications (death, damage to bowel or urinary tract).

Results: This study included 39 women with PAS grade 3 in the UK, 51 in France, and 34 in Italy, a total of 124 women. PAS was suspected before birth in 59% of the UK cases, 88% in France, and 82% in Italy (P < .01). Conservative management was attempted only in the UK (38%) and in France (61%). PPH ≥ 3000 mL occurred in 54% of the UK women, 25% in France, and 12% in Italy (P < .01); 67% in the UK, 47% in France, and 41% in Italy received blood transfusion ≥ 4 units (P = .06). The final (immediate and secondary) hysterectomy rate differed significantly between the three countries: 69% in the UK, 57% in France, 100% in Italy (P < .01).

Conclusion: Maternal outcomes in women with grade 3 PAS varied between the three periods and countries, alongside the evolution in prenatal screening and peri-operative management.

Trial registration: For the UK: reference number: RP-PG-0608-10038. For France: reference number: AOR12156. For Italy: reference number: Port. PRE-839/13.

Keywords: Placenta accreta; Population-based study; Post-partum hemorrhage.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: For the UK, this study was approved by the London Research Ethics Committee (ref. 10/H0717/20). The need for consent to participate was also waived by the ethics committee that approved this study. Data ware fully anonymized before being accessed and analyzed. For France, PACCRETA The appropriate ethics committees (Consultative Committee on the Treatment of Data on Personal Health for Research Purposes – reference no. AOR12156; 12/19/2013, and the Committee for the Protection of People Participating in Biomedical Research – reference CPP 13–017; 05/28/2013), and the National Data Protection Authority (CNIL no. DR-2013-427; 12/20/2013) approved the study. The need for consent to participate was also waived by the ethics committee that approved this study. Data ware fully anonymized before being accessed and analyzed. For Italy, the study was approved by the Committee of the Italian National Institute of Health (Port. PRE-839/13). The need for consent to participate was also waived by the ethics committee that approved this study. Data ware fully anonymized before being accessed and analyzed. Consent for publication: Not applicable. Consent to publish: All authors consent to the publication of this manuscript. Competing interests: The authors declare no competing interests.

References

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