title: Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care.
abstract: OBJECTIVE
  To compare maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team with similar cases managed by standard obstetric care.
  
  
  METHODS
  This was a retrospective cohort study of all cases of placenta accreta identified in the State of Utah from 1996 to 2008. Cases of placenta accreta were identified using International Classification of Diseases (ICD-9) codes for placenta accreta, placenta previa, and cesarean hysterectomy. Maternal morbidity was compared for cases managed by a multidisciplinary care team in two tertiary care centers and similar cases managed at 26 other hospitals using multivariable logistic regression analysis.
  
  
  RESULTS
  One-hundred forty-one cases of placenta accreta were identified including 79 managed by a multidisciplinary care team and 62 cases managed by standard obstetric care. Women managed by a multidisciplinary care team were less likely to require large-volume blood transfusion (4 or more units of packed red blood cells) (43% compared with 61%, P=.031) and reoperation within 7 days of delivery for bleeding complications (3% compared with 36%, P<.001) compared with women managed by standard obstetric care. Women with suspected placenta accreta managed by a multidisciplinary team were less likely to experience composite early morbidity (prolonged maternal admission to the intensive care unit, large-volume blood transfusion, coagulopathy, ureteral injury, or early reoperation) than women managed by standard obstetric care (47% compared with 74%, P=.026). The odds ratio of composite early morbidity in women managed by a multidisciplinary team was 0.22, (95% confidence interval, 0.07- 0.70) in the multivariable model.
  
  
  CONCLUSIONS
  Maternal morbidity is reduced in women with placenta accreta who deliver in a tertiary care hospital with a multidisciplinary care team.
  
  
  METHODS
  II
authors.affiliation: From Intermountain Healthcare, Murray, Utah; the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and the Office of Health Care Statistics, Utah Department of Health, Salt Lake City, Utah.
authors.forename: Alexandra G
authors.initials: AG
authors.lastname: Eller
authors.forename: Michele A
authors.initials: MA
authors.lastname: Bennett
authors.forename: Margarita
authors.initials: M
authors.lastname: Sharshiner
authors.forename: Carol
authors.initials: C
authors.lastname: Masheter
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Soisson
authors.forename: Mark
authors.initials: M
authors.lastname: Dodson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000706:statistics & numerical data; D014589:Utah / Q000453:epidemiology; D055815:Young Adult