78 - Outcomes of the UT-PAS protocol: Uterine artery embolization and Tranexamic acid for Placenta Accreta Spectrum

Objective: Placenta Accreta Spectrum (PAS) disorders are a continuum of placental pathologies with significant maternal morbidity and mortality. Morbidity is related to the overall degree of placental adherence, thus patients with placenta increta or percreta represent a high-risk category of patients. Hemorrhage and transfusion of blood products represent 90% of PAS morbidity. Both tranexamic acid (TXA) and uterine artery embolization (UAE) independently decrease obstetric hemorrhage. Our objective was to provide an evidence-based intraoperative protocol for PAS management needed for the standardization and optimization of these complex cases.

Study Design:
This study was a pre- and post-implementation analysis of concomitant UAE and TXA, 1g IV after cord clamping, in cases of patients with antenatally suspected placenta increta and percreta over a 5-year period (2018-2022). As a control, a 5-year (2013-2017) pre-implementation group was used to assess the impact of the UT-PAS protocol. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. 



Results: A total of 126 cases were managed by the PAS team over the 10-year time period, of which, 64 cases had suspected placenta increta/percreta. Thirty patients (47%) were treated after implementation of UT-PAS and thirty-four (53%) pre-implementation patients did not undergo UAE or TXA infusion. Post-implementation, while operative times were longer (416 vs 187 min, p< 0.01) and patients were more likely to receive general anesthesia (80% vs 47%, p< 0.01), blood loss was reduced by 33% (2000cc vs 3000cc, p=0.03), overall blood transfusion rates decreased by 51% (OR=0.05 [95%CI 0.001, 0.20] p< 0.01) and massive blood transfusion ( >10 units transfused) was reduced 5-fold (OR=0.17 [95%CI 0.02, 0.17], p=0.02). Post-operative complication rates remained unchanged (9 vs 10 events, p=1.0). Neonatal outcomes were equivalent.

Conclusion: The UT-PAS protocol is a highly efficient approach at the standardization of complex PAS cases with optimal outcomes, appropriate utilization of resources and reduced maternal morbidity.