(430) Pre-operative planning for placenta accreta spectrum and delivery outcomes

At our institution, pre-operatively identified placenta accreta spectrum (PAS) cases are discussed in a multidisciplinary meeting (MDM) to optimize surgical planning. We sought to determine if our MDM approach improves clinical outcomes of women with PAS.

Study Design:

Retrospective cohort study at a single institution from January 2013 to December 2021. Patients diagnosed (antenatal or postnatal) with PAS were identified through record review (placental pathology, cesarean hysterectomy, and Accreta Center records) and divided into groups based on if they had a MDM. Our primary outcomes were total blood products transfused and intraoperative complications. Data regarding maternal demographics, length of hospital stay, delivery admission and post-discharge complications were collected. Statistical analysis was performed using Chi square tests, student T-tests, and logistic regression modeling, with statistical significance defined as p< 0.05.

Results:

There were 40 patients with a preoperative PAS diagnosis: 21 had a MDM and 19 did not have a MDM. MDM was not significantly associated with any of the studied outcomes (Figure 1). Planned (35.7%) versus unplanned (3.3%) hysterectomy was associated with statistically significant increased risk of post-discharge complications (p=0.009). Planned hysterectomy was associated with a longer length of stay, 6.86 days versus 2.43 days (p=0.002). Planned hysterectomy did not have significant correlation with intraoperative or delivery admission complications, number of blood products transfused, or ICU admission. Peri-operative complications did not differ between groups (Table 1). There were no instances of ureteral injury, uterine rupture, stroke, MI, PNA, SBO, ileus, fever, acute respiratory failure, DIC, and post-discharge VTE.

Conclusion:

Pre-operative MDM did not improve clinical outcomes of women affected with PAS. Planned hysterectomy was associated with longer length of stay and more post-discharge complications, however women with a planned hysterectomy may represent a cohort of women with more complicated cases at risk for increased complications.