title: Multidisciplinary management of invasive placenta previa.
abstract: OBJECTIVE
  To assess the effectiveness of a multidisciplinary team approach to reduce severe maternal morbidity in women with invasive placenta previa.
  
  
  METHODS
  We conducted a prospective study of 33 women with placenta previa and increta-percreta (diagnosed by ultrasound and/or magnetic resonance imaging) delivering at Mount Sinai Hospital, Toronto, following the introduction in January 2008 of a team-based approach to women with this condition. We included women who delivered by June 2012. We reviewed antenatal outpatient and inpatient records for use of six pre-defined team components by the attending staff obstetrician: (1) antenatal maternal-fetal medicine consultation, (2) surgical gynaecology consultation, (3) antenatal MRI, (4) interventional radiology consultation and preoperative placement of balloon catheters in the anterior divisions of the internal iliac arteries, (5) pre-planned surgical date, and (6) surgery performed by members of the invasive placenta surgical team. Antenatal course, delivery, and postpartum details were recorded to derive a five-point composite severe maternal morbidity score based on the presence or absence of: (1) ICU admission following delivery, (2) transfusion > 2 units of blood, (3) general anaesthesia start or conversion, (4) operating time in highest quartile (> 125 minutes), and (5) significant postoperative complications (readmission, prolonged postpartum stay, and/or pulmonary embolism).
  
  
  RESULTS
  All 33 women survived during this time period. Two thirds (22/33) had either five or six of the six components of multidisciplinary care. Increasing use of multidisciplinary team components was associated with a significant reduction in composite morbidity (R2 = 0.228, P = 0.005).
  
  
  CONCLUSIONS
  Team-based assessment and management of women with invasive placenta previa is likely to improve maternal outcomes and should be encouraged on a regional basis.
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Walker
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Lisa
authors.initials: L
authors.lastname: Allen
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Rory C
authors.initials: RC
authors.lastname: Windrim
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Vascular and Interventional Radiology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: John
authors.initials: J
authors.lastname: Kachura
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Pollard
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Diagnostic Imaging, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Sophia
authors.initials: S
authors.lastname: Pantazi
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Sarah
authors.initials: S
authors.lastname: Keating
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Jose C A
authors.initials: JC
authors.lastname: Carvalho
authors.affiliation: The Invasive Placenta Team, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: John C P
authors.initials: JC
authors.lastname: Kingdom
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D010923:Placenta Previa / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012720:Severity of Illness Index; D055815:Young Adult
keywords: bladder injury; hemorrhage; invasive placentation; placenta increta; placenta percreta; placenta previa; severe obstetric morbidity