Impact of a standardised diagnostic protocol on the management and outcome of patients at high-risk of placenta accreta spectrum

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Objective: To examine the impact of a standardised ultrasound-pathology diagnostic protocol on the management and outcome of patients presenting with a high risk of placenta accreta spectrum (PAS). Design: Time-to-event analysis. Setting: Cairo University Hospitals, Egypt. Population: Patients with a high probability of PAS managed by a specialist MDT between January 2015 and January 2025. Methods: This observational study examined and compared data obtained before (2015-2018; n=110) and after (2019-2025; n=227) the introduction of a standardised protocol for the MDT to correlate preoperative ultrasound images, intraoperative findings, and fresh macroscopic examination of surgical specimens. Main Outcomes Measures: Type of skin incision, peripartum hysterectomy (PH), bladder injury rates, and intraoperative blood loss. Results: The rates of midline vertical abdominal skin incision, PH, and bladder injuries decreased significantly, after 2019, from 100% to 65% ( P <.001); from 94.5% to 52% ( P <.001), and from 20% to 8% ( P <.002), respectively. The severity of blood loss and the number of units of packed red blood cells (PRBC) transfused peripartum increased significantly ( P <.001 and P <.002, respectively) between the two study periods. Yearly trends during the 2019-2025 period showed a significant decrease over time for all four parameters. Conclusions: Implementing a standardised diagnostic protocol that reports on detailed ultrasound, intraoperative, and macroscopic findings at delivery provides accurate epidemiological data on the prevalence and incidence of PAS, which is essential for healthcare provision and a reproducible management strategy for patients with PAS. It should also facilitate continuous education and capacity building for the MDT.

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