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CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(12): e747-e753
DOI: 10.1055/s-0043-1772482
Original Article
High Risk Pregnancy

Placenta Accreta Spectrum Disorders – The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal

Patologia do espectro do acretismo placentário – O impacto da criação de uma equipa multidisciplinar nos desfechos maternos em Portugal
Beatriz Teixeira 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Pedro Viana Pinto 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
2   Department of Anatomy, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
3   Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
,
Rodrigo Realista 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Manuela Silva 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Antónia Costa 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
3   Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
,
Ana Paula Machado 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Marina Moucho 
1   Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Abstract

Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT).

Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group – 2010–2014; and MDT group – 2015–2021. Descriptive analysis of their characteristics and maternal outcomes.

Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy – one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units.

Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo

Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT).

Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) – 2010–2014; e grupo MDT – 2015–2021. Análise descritiva de suas características e desfechos maternos.

Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto – uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades.

Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Keywords

placenta accreta spectrum disorders - multidisciplinary team - maternal morbidity

Palavras-chave

distúrbios do espectro da placenta acreta - equipe multidisciplinar - morbidade materna

Contributions

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.




Publication History

Received: 08 April 2023

Accepted: 14 July 2023

Article published online:
23 December 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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