OP19.07: A multidisciplinary team as an intervention to improve maternal and perinatal outcomes in placenta accreta spectrum (PAS)

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Describe an intervention designed to improve maternal/perinatal outcomes when PAS is diagnosed antenatally. A multidisciplinary team created in 02/2018: MFM, gyn/oncology, obstetric anesthesia, gynecology, blood bank, interventional radiology, ICU, urology, radiology, nursing, laboratory, social services; general and vascular surgery as needed SMFM (AJOG 2010). A mandatory meeting before 30 weeks of gestation=development of a management plan and follow-up for each case. Review of de-identified medical records using ICD-9&10 codes placenta accreta, increta, percreta from 01/2015-02/2019 at a large referal centre. Comparison of maternal and perinatal, surgical/anesthesia outcomes before/after 02/2018. Descriptive analysis of important clinical outcomes. Statistical analysis of outcomes using Fishers exact test and two-sided T-tests; small sample size. Nine Patients pre- and nine post-intervention. Two black, 11 white, four hispanic and one asian. 17/18 multigravida; 14/18 previous Caesarean section, 1 myomectomy. 4/18 smokers; 18/18 singleton; antenatal Dx of accreta 9/18 increta 2/18 percreta 2/18; no Dx: 5/18. US: vascular lacunae:12/18; loss hypoechoic retroplacental zone: 10/18; myometrail thick < 1 mm: 3/18. Blood vessels myom/bladder: 11/18; Previa: 12/18. MRI: 4/18. Pathology confimed PAS: 15/18. Mean gestational age at delivery (32.9, 33.9) p: 0.72; received transfusion (%) (66.6, 33.3) p: 0.35; mean EBL (1711, 1222) p 0.3; ICU admission (%) (22.2, 11.1) 0.9; maternal mean LOS (days) (7.1, 5.6) p: 0.59; NICU admission (%) (66.6, 55.5) 0.99; NICU mean LOS (days) (13.0, 11.2) p: 0.76; gyn-oncology involved (55.5, 87.5) 0.29; urology (11.1 12.5) p: 0.99; IR involved (%) (33.3, 14.3); p: 0.57; stents used (%) (22.2, 33.3) 0.99; central/arterial line used (%) (44.4,71.4) p:0.35. Variables presented as before, after, p value. Establishment of a multidisciplinary team at a referral teaching centre for management of patients diagnosed with PAS, even with a small sample size being analysed, resulted in improvement in important clinical outcomes. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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