Placenta Accreta Spectrum Outcomes with a Multidisciplinary Team and Standardized Ultrasound Approach

Abstract

This study aimed to compare outcomes before and after starting a multidisciplinary PAS team with a standardized ultrasound approach.Retrospective cohort study of deliveries ≥ 24 weeks complicated by PAS from August 2009 to April 2022 at a large tertiary care hospital. The multidisciplinary team started in October 2020, and a standardized ultrasound approach was consistently practiced. We compared demographics and pregnancy characteristics before and after the formation of the PAS team. Statistical analysis included Fisher's exact test and χ ² for categorical variables student's t-test and Kruskal-Wallis test for continuous variables.Of 244 patients, 32 delivered with and 212 delivered before the PAS team. Median gestational age at delivery did not change (37 [36-38] vs. 37 [36-37] weeks before the team, p = 0.680). With the team, 31/32 cases of PAS were prenatally diagnosed (97%) compared with 177/212 (83%) before the team (p = 0.058). There were more cases of false positive prenatal suspicion present with the team (11% vs. 31%). Fewer hysterectomies occurred with the team at 21 (66%) versus 197 (93%) before the team, (p < 0.001). Pathologic severity in hysterectomy specimens significantly differed (p = 0.032), with 10 cases with negative pathology before and none with the team. Due to the lower rate of hysterectomy, the overall median EBL was lower with the team (p = 0.018), but other outcomes were similar. This difference in EBL did not persist when limiting to hysterectomy cases. Maternal LOS overall (6 [5-9] vs. 8 [5-15] days, p = 0.031) and within hysterectomies (6 [5-8] vs. 9 [6-16] days, p = 0.042) was significantly shorter with the team.A multidisciplinary PAS team with a standardized ultrasound approach decreased unnecessary hysterectomies and reduced the length of stay at a large tertiary hospital. A higher rate of false positive prenatal suspicion was observed. This finding supports a need for improved prenatal diagnosis to enable better preoperative risk stratification and planning. · A multidisciplinary PAS team with standardized ultrasound reduces unnecessary hysterectomy.. · Heightened assessment increased identification prenatally resulting in more false positive cases.. · Our findings highlight the need for improved preoperative risk stratification and planning..