title: Maternal and fetal outcomes in placenta accreta after institution of team-managed care.
abstract: BACKGROUND
  Placenta accreta significantly contributes to maternal morbidity and mortality. We evaluated whether planned delivery and experienced, team-managed surgical intervention results in improved outcomes. We also examined whether risk factors differed for accreta, increta, and percreta and evaluated whether excess lower segment uterine vascularity correlates with disease severity.
  
  
  METHODS
  We retrospectively analyzed patients before versus after institution of a management protocol. Of the 58 044 deliveries over 10 years, there were 67 women whose pregnancies were histopathologically confirmed as placenta accreta, increta, or percreta (1/866). Clinical outcome measures were estimated blood loss (EBL), packed red blood cells (pRBCs) transfused, maternal and fetal complications, intensive care unit admission, and length of stay.
  
  
  RESULTS
  There were no maternal or infant deaths. In the managed cohort, EBL was reduced by 48% (P < .001), intraoperative pRBCs transfused by 40% (P < .01), total transfused pRBCs per case by 50% (P < .01), and surgical intensive care unit admissions by >50% (P < .01). Assessment of maternal risk factors by diagnosis revealed marked differences between accreta versus increta and percreta. Clinically assessed excess vascularity of the lower uterine segment correlated with disease severity. The incidence of neonatal complications was similar in both cohorts.
  
  
  CONCLUSIONS
  Targeted delivery at 34 weeks and team-managed diagnosis, treatment, and care of patients with placenta accreta were associated with improved maternal, but not neonatal outcomes.
authors: 1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Surgery, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Abdulla
authors: A
authors: Al-Khan
authors: Vivek
authors: V
authors: Gupta
authors: Nicholas P
authors: NP
authors: Illsley
authors: Ciaran
authors: C
authors: Mannion
authors: Christopher
authors: C
authors: Koenig
authors: Adam
authors: A
authors: Bogomol
authors: Manuel
authors: M
authors: Alvarez
authors: Stacy
authors: S
authors: Zamudio
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D010348:Patient Care Team / Q000639:trends*; D010921:Placenta Accreta / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: increta; percreta; peripartum hemorrhage; surgical management; transfusion