Placenta accreta spectrum: We can do better

Background: Placenta accreta spectrum (PAS) has a high risk of maternal morbidity, and requires meticulous antenatal and peripartum management.

Aims: To compare the management and outcomes of PAS between women with and without antenatally suspected disease, and to evaluate the effect of multidisciplinary team (MDT) management.

Materials and methods: A retrospective cohort study identified all hysterectomy specimens with a histopathological diagnosis of PAS in the Western Sydney Local Health District between January 2006 and December 2019, and analysed each patient's clinical course.

Results: Seventy patients had PAS diagnosed on hysterectomy specimens, of which 38 cases (54%) were antenatally suspected. Women with suspected PAS were more likely to have a previous caesarean section (100% vs 68%, P < 0.001), placenta praevia (92% vs 56%, P < 0.001) and anterior placenta (95% vs 66%. P = 0.011). Suspected PAS was associated with less maternal blood loss (median blood loss 2000 mL vs 4000 mL, P < 0.001), fewer red blood cell transfusions (median four units vs nine units, P < 0.001), and shorter intensive care or high dependency unit admission (mean stay one day vs three days, P = 0.037). There were no significant differences in other maternal morbidities. MDT management was associated with a clinically significant reduction in maternal blood loss (1500 mL vs 2520 mL, P = 0.09) and red blood cell transfusion (one unit vs six units, P = 0.04). The mean gestation of delivery was 37 weeks in both groups with no differences in neonatal morbidity.

Conclusions: Both antenatally diagnosed PAS and MDT management reduced blood loss and blood transfusion. Elective delivery at 37 weeks gestation reduces the neonatal risks of preterm delivery.