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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Planned Management of Cesarean Deliveries with Morbidly Adherent Placenta: Trends from 2010-2017 in A Tertiary Center

Abstract Number: T5B-2
Abstract Type: Original Research

Elena Reitman MD1 ; Laurence Ring MD2; Allison Lee MD3; Annette Perez-Delboy MD4; Jason D. Wright MD5; Ruth Landau MD6

Background

The incidence of placenta accreta (PAC) has increased to 3:1000 deliveries, parallel to the increasing CD rate,(1) and the associated maternal mortality remains high. Uterine artery embolization (UAE) seems to be beneficial in decreasing placental blood flow to allow for conservative management with interval hysterectomy, however evidence-based guidelines are lacking and data remains inconclusive.(2) Our aim was to evaluate outcomes in cases with a suspected morbidly adherent placenta (SMAP) during pregnancy who underwent a planned CD; we hypothesized that outcomes improved over time with tailored resources and interventions.

Methods

All scheduled CDs with a US/MRI based SMAP managed in the general OR by a dedicated 'Accreta Program' team since 2010, were included in this retrospective study. Outcomes were compared by dividing the study period into 2 epochs: T1 01/2010-08/2015; T2 09/2015-12/2017. Resources and interventions included ureteral stents by urology, uterine artery balloon stents (UABS) by interventional radiology (IR), and UAE by IR or vascular surgery. Anesthesia protocol included a neuraxial (CSE) followed by general anesthesia (GA) if confirmed PA, with invasive monitoring in all cases. Demographic data, pregnancy outcomes and complications were recorded.

Results

A total of 99 SMAP were identified, of which 13 (5 in T1; 8 in T2) did not have a PAC, resulting in 86 cases entered in the analysis (Table). There was an increase in cases in T2, mostly PACs. UABS were predominantly used in T1 while UAE use increased in T2. EBL and transfusion use were lower in T2, GA use increased in T2, hospital stay was lower in T2 and so was ICU admission and readmission rates. Complications occurred in 42 cases; there were 2 cases of DVT after difficult central line placements, both women had received prophylactic TXA.

Conclusion

A practice change was identified between 2010 and 2017, with an increase in the use of vascular surgery services for perioperative UAE, which resulted in more staged hysterectomies. The reason for GA increase is unclear and remains to be investigated. While we cannot determine whether it is this change in practice, or a combination of better resource utilization and the increased interdisciplinary experience of the Accreta Program, it is encouraging to note that the complication rate is overall decreasing, although DVTs were noted.

1. Obstet Gynecol 2012;120:207-11

2. Am J Obstet Gynecol 2015;213(6):755-60



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