(413) Severe morbidity for placenta accreta spectrum has decreased over time in referral centers

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: In 2015, national experts published criteria to define placenta accreta spectrum (PAS) centers of excellence with a goal of improving outcomes. We aimed to (1) characterize the incidence of severe morbidity for placenta accreta spectrum (PAS) patients undergoing hysterectomy at referral centers in a contemporary cohort after 2015 and (2) to evaluate trends in morbidity over time.

Study Design: A retrospective cohort study of patients from 5 PAS referral centers with multidisciplinary care from 1997–2021 using PAS confirmed cases (histopathologically or clinically) managed by hysterectomy. The primary outcome, severe morbidity, defined as the composite of maternal death, transfusion of ≥4 units red blood cells, urinary tract injury, unplanned reoperation, pulmonary edema, acute renal failure, or venous thromboembolism was compared in cases managed before 2015 versus the more contemporary cohort (Table). Trend analysis over time was completed using JoinPoint software (Figure). We then controlled for history of cesarean, presence of previa, and disease severity in a multivariable logistic model.

Results:

There were 859 cases of PAS. Key baseline characteristics, risk factors, and disease severity did not differ between cohorts (Table). In the contemporary cohort (N=510), severe PAS morbidity occurred in 37.1% (95% CI, 32.9-41.3), significantly lower than pre-2015 (49.9% (44.6-55.1), p< 0.001). Over the study period, severe PAS morbidity decreased by an annual percent change (APC) of 3.9% (2.5% - 5.3%, p< 0.001). No distinct year-to-year changes in this downward trend were identified by permutation testing.

Conclusion:

In these referral centers, severe PAS morbidity was significantly less frequent from 2015-2021 compared to pre-2015 and decreased steadily over time. Change in patient demographics and clinical characteristics do not explain the decrease in PAS morbidity.

Primary & Presenting Author(s)

Brett D. Einerson, MD, MPH (he/him/his)
Assistant Professor, Director of The Utah Placenta Accreta Program
University of Utah Health
Salt Lake City, Utah, United States

Coauthor(s)

AA
Amanda A. Allshouse, MS
Perinatal Biostatistician
University of Utah
Salt Lake City, Utah, United States
Scott A. Shainker, MS,DO (he/him/his)
Director, New England Center for Placental Disorders / Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
MK
Meena Khandelwal, MD
Attending Physician
Cooper University Hospital
Camden, New Jersey, United States
Albaro J. Nieto-Calvache, MD (he/him/his)
Abnormally Invasive Placenta Clinic
Fundación Valle del Lili
Cali, Valle del Cauca, Colombia
GF
Garrett Fitzgerald, MD
Assistant Professor
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Vineet Shrivastava, MD
Long Beach Memorial Medical Center Women's Hospital and UC Irvine
Long Beach, California, United States
Lisa C. Zuckerwise, MD (she/her/hers)
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
CW
Christine M. Warrick, MD (she/her/hers)
University of Utah Department of Anesthesiology
Salt Lake City, Utah, United States
Karin A. Fox, MD
Assistant Professor
Baylor College of Medicine and Texas Children's Hospital
Houston, Texas, United States
Daniela A. Carusi, MD, MSCR (she/her/hers)
Associate Professor
Brigham and Women's Hospital and Harvard Medical School
Boston, Massachusetts, United States
AS
Alireza Shamshirsaz, MD
Department of Obstetrics & Gynecology, Division of Fetal Intervention, Baylor College of Medicine and Texas Children’s Hospital
Houston, Texas, United States
DL
Deirdre J. Lyell, MD
Professor
Stanford University
Palo Alto, California, United States
BS
Bob M. Silver, MD
Chair OB/GYN
Univ. of Utah School of Medicine
Salt Lake City, Utah, United States