title: Invasive placental disease: the impact of a multi-disciplinary team approach to management.
abstract: OBJECTIVE
  To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD).
  
  
  METHODS
  This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started.
  
  
  RESULTS
  There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260 min versus 181 min, p = 0.0001), less blood loss (1200 mL versus 2500 mL, p = 0.009), less administration of blood products (47.4% versus 85.7%, p = 0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57 mmHg versus 48 mmHg, p = 0.002, when compared to the No-MDT (n = 28) approach. No differences were found for other outcomes.
  
  
  CONCLUSIONS
  Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.|b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Smulian
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.
authors.forename: Ana-Liza
authors.initials: AL
authors.lastname: Pascual
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.
authors.forename: Helai
authors.initials: H
authors.lastname: Hesham
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.
authors.forename: Emma
authors.initials: E
authors.lastname: Qureshey
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.|b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.
authors.forename: M
authors.initials: M
authors.lastname: Bijoy Thomas
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.|b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Depuy
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.|b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Flicker
authors.affiliation: a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.|b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Scorza
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D010922:Placenta Diseases / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Invasive placenta; accreta; multidisciplinary team; perinatal outcomes