Clinical impact of a placenta accreta spectrum care national system in a Central American country

Abstract

Objective: We describe the process of building a national placenta accreta spectrum care system in a Central American country, using inter-institutional collaboration as a strategy to support an accreta team in a limited resource scenario. Clinical outcomes were measured before, during, and after the intervention.

Methods: Ambispective analysis of clinical outcomes before, during, and after the design and implementation of a centralized system for the management of patients with placenta accreta spectrum in Nicaragua, involving a multidisciplinary team responsible for the care of all patients. Medical records served as the data source prior to the program, and subsequently, prospective clinical data collection was conducted during patient care by the multidisciplinary team.

Results: There was a reduction in the number of patients taken to surgery with a suspected placenta accreta spectrum, along with fewer false positives (46.4% before vs. 10.5% after the program) and false negatives (10 cases before vs. 1 case after the program) in both prenatal and intraoperative diagnosis. We also observed a decrease in the frequency of transfusions (71.4% before vs. 42.1% after the program), hysterectomy rates (100% before vs. 21% after the program), and intensive care unit admissions (78.5% before vs. 47.3% after) following implementation of the program.

Conclusion: Centralizing placenta accreta spectrum patients and ensuring their care by a trained multidisciplinary team in permanent virtual contact with other placenta accreta spectrum experts is associated with better clinical outcomes.

Keywords: individualized treatment; low resource setting; multidisciplinary team; placenta accreta spectrum; reference system.