(951) The Effects of a Systematic Maternal-Fetal Medicine directed Placenta Accreta Spectrum Service

While multidisciplinary care is the cornerstone for placenta accreta spectrum (PAS), institutional variation occurs widely in regard to who performs such care, i.e. Maternal-Fetal Medicine (MFM) or Gynecologic Oncology (GYO).  Additionally, the optimal surgical location, general operating room (GOR) versus Labor and Delivery (L&D) is undefined.  In 2018, our center implemented a systematic change in cesarean hysterectomy (C-HYST) for PAS being GYO-directed to MFM-directed. We also changed primary location for scheduled PAS C-HYST from the GOR to L&D. We sought to examine patient outcomes and resource utilization after this implementation.

Study Design:

This is a single site, retrospective cohort study examining C-HSYT for PAS performed from 2008-2022.  The comparison is of those performed by a GYO-directed team (2008-2017) to those of an MFM-directed team (2018-2022).  All cases were confirmed with both clinical and pathological diagnoses for PAS.  Primary surgeon/team was classified as MFM-directed if the entire hysterectomy portion was completed without GYO.  Associations were assessed using chi-square tests, Mann-Whitney U tests, or t-tests.

Results:

After transition to MFM-directed PAS C-HYST (2018-2022), there was a statistically significant decrease in resource utilization, e.g. GOR utilization, intensive care unit (ICU) admission, postoperative length of stay, and intraoperative consultation (Table 1).  Severe maternal morbidity remained unchanged between groups except for postoperative infections which decreased in the MFM-directed group. (Table 2). 

Conclusion: C-HSYT performed by a systematic, specialized MFM-directed service may be associated with similar or improved maternal outcomes, and lower resource utilization than GYO-directed C-HYST.