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Am J Perinatol
DOI: 10.1055/a-2626-3120
Original Article

Placenta Accreta Spectrum Outcomes with a Multidisciplinary Team and Standardized Ultrasound Approach

Elise A. Rosenthal
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
2   Parkland Health, Dallas, Texas
,
Ashlyn K. Lafferty
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
,
Jessica E. Pruszynski 
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
,
Naseem Uddin
2   Parkland Health, Dallas, Texas
3   Department of Pathology, UT Southwestern Medical Center, Dallas, Texas
,
Catherine Y. Spong
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
2   Parkland Health, Dallas, Texas
,
Christina L. Herrera 
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
2   Parkland Health, Dallas, Texas
› Author Affiliations
Funding This research was made possible through internal funding. C.L.H. is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under award number K23HD103876 and the National Institutes of Health (NIH) under award number L30HD109864.
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Abstract

Objective

This study aimed to compare outcomes before and after starting a multidisciplinary PAS team with a standardized ultrasound approach.

Study Design

Retrospective cohort study of deliveries ≥ 24 weeks complicated by PAS from August 2009 to April 2022 at a large tertiary care hospital. The multidisciplinary team started in October 2020, and a standardized ultrasound approach was consistently practiced. We compared demographics and pregnancy characteristics before and after the formation of the PAS team. Statistical analysis included Fisher's exact test and χ 2 for categorical variables student's t-test and Kruskal–Wallis test for continuous variables.

Results

Of 244 patients, 32 delivered with and 212 delivered before the PAS team. Median gestational age at delivery did not change (37 [36–38] vs. 37 [36–37] weeks before the team, p = 0.680). With the team, 31/32 cases of PAS were prenatally diagnosed (97%) compared with 177/212 (83%) before the team (p = 0.058). There were more cases of false positive prenatal suspicion present with the team (11% vs. 31%). Fewer hysterectomies occurred with the team at 21 (66%) versus 197 (93%) before the team, (p < 0.001). Pathologic severity in hysterectomy specimens significantly differed (p = 0.032), with 10 cases with negative pathology before and none with the team. Due to the lower rate of hysterectomy, the overall median EBL was lower with the team (p = 0.018), but other outcomes were similar. This difference in EBL did not persist when limiting to hysterectomy cases. Maternal LOS overall (6 [5–9] vs. 8 [5–15] days, p = 0.031) and within hysterectomies (6 [5–8] vs. 9 [6–16] days, p = 0.042) was significantly shorter with the team.

Conclusion

A multidisciplinary PAS team with a standardized ultrasound approach decreased unnecessary hysterectomies and reduced the length of stay at a large tertiary hospital. A higher rate of false positive prenatal suspicion was observed. This finding supports a need for improved prenatal diagnosis to enable better preoperative risk stratification and planning.

Key Points

  • A multidisciplinary PAS team with standardized ultrasound reduces unnecessary hysterectomy.

  • Heightened assessment increased identification prenatally resulting in more false positive cases.

  • Our findings highlight the need for improved preoperative risk stratification and planning.

Keywords

placenta accreta spectrum - quality improvement - multidisciplinary team - standardized ultrasound approach - preoperative risk stratification - severe maternal morbidity - blood transfusion - hysterectomy - length of stay

Supplementary Material



Publication History

Received: 29 October 2024

Accepted: 02 June 2025

Article published online:
27 June 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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