1. Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum
- Author
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Morlando, Maddalena, Schwickert, Alexander, Stefanovic, Vedran, Gziri, Mina M., Pateisky, Petra, Chalubinski, Kinga M., Nonnenmacher, Andreas, Morel, Olivier, Braun, Thorsten, Bertholdt, Charline, Beekhuizen, Heleen J. Van, Collins, Sally L., Calda, Pavel, Chantraine, Fredric, Duvekot, Johannes J., Fox, Karin A., Gronbeck, Lene, Henrich, Wolfgang, Martinelli, Pasquale, Paavonen, Jorma, Petit, Philippe, Rijken, Marcus, Ropacka, Mariola, Tikkanen, Minna, Weichert, Alexander, Weizsäcker, Katharina, International Society For Placenta Accreta Spectrum (IS‐PAS), HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, Helsinki University Hospital Area, University of Helsinki, UCL - (SLuc) Service d'obstétrique, UCL - SSS/IREC/SLUC - Pôle St.-Luc, Università degli studi di Napoli Federico II, Università degli studi della Campania 'Luigi Vanvitelli', Freie Universität Berlin, Humboldt-Universität zu Berlin, Cliniques Universitaires Saint-Luc [Bruxelles], Université médicale de Vienne, Autriche, Service d'Obstétrique et de Gynécologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Nuffield (Nuffield), University of Oxford [Oxford], John Radcliffe Hospital [Oxford University Hospital], Morlando, Maddalena, Schwickert, Alexander, Stefanovic, Vedran, Gziri, Mina M, Pateisky, Petra, Chalubinski, Kinga M, Nonnenmacher, Andrea, Morel, Olivier, Braun, Thorsten, Bertholdt, Charline, Van Beekhuizen, Heleen J, Collins, Sally L, Obstetrics and Gynaecology, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Gynecological Oncology, and Obstetrics & Gynecology
- Subjects
Emergency Medical Services ,Databases, Factual ,Maternal Health ,Cohort Studies ,maternal morbidity ,placenta accreta spectrum ,0302 clinical medicine ,Retrospective Studie ,Pregnancy ,3123 Gynaecology and paediatrics ,030212 general & internal medicine ,gestational age ,ComputingMilieux_MISCELLANEOUS ,030219 obstetrics & reproductive medicine ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Pregnancy Complication ,3. Good health ,Europe ,Gestation ,Female ,medicine.symptom ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit ,Human ,United State ,Adult ,medicine.medical_specialty ,Referral ,Placenta accreta ,Gestational Age ,Hemorrhage ,[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,Placenta Accreta ,03 medical and health sciences ,abnormally invasive placenta ,medicine ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Vaginal bleeding ,Infant Health ,Risk factor ,Retrospective Studies ,Antepartum hemorrhage ,business.industry ,Cesarean Section ,neonatal morbidity ,medicine.disease ,Confidence interval ,United States ,Pregnancy Complications ,Cohort Studie ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Introduction: Placenta accreta spectrum (PAS) is a condition often resulting in severe maternal morbidity. Scheduled delivery by an experienced team has been shown to improve maternal outcomes; however, the benefits must be weighed against the risk of iatrogenic prematurity. The aim of this study is to investigate the rates of emergency delivery seen for antenatally suspected PAS and compare the resulting outcomes in the 15 referral centers of the International Society for PAS (IS-PAS). Material and methods: Fifteen centers provided cases between 2008 and 2019. The women included were divided into two groups according to whether they had a planned or an emergency cesarean delivery. Delivery was defined as “planned” when performed at a time and date to suit the team. All the remaining cases were classified as “emergency”. Maternal characteristics and neonatal outcomes were compared between the two groups according to gestation at delivery. Results: In all, 356 women were included. Of these, 239 (67%) underwent a planned delivery and 117 (33%) an emergency delivery. Vaginal bleeding was the indication for emergency delivery in 41 of the 117 women (41%). There were no significant differences in terms of blood loss, transfusion rates or major maternal morbidity between planned and emergency deliveries. However, the rate of maternal intensive therapy unit admission was increased with emergency delivery (45% vs 33%, P =.02). Antepartum hemorrhage was the only independent predictor of emergency delivery (aOR: 4.3, 95% confidence interval 2.4-7.7). Emergency delivery due to vaginal bleeding was more frequent with false-positive cases (antenatally suspected but not confirmed as PAS at delivery) and the milder grades of PAS (accreta/increta). The rate of infants experiencing any major neonatal morbidity was 25% at 34+1 to 36+0 weeks and 19% at >36+0 weeks. Conclusions: Emergency delivery in centers of excellence did not increase blood loss, transfusion rates or maternal morbidity. The single greatest risk factor for emergency delivery was antenatal hemorrhage. When adequate expertise and resources are available, to defer delivery in women with no significant antenatal bleeding and no risk factors for pre-term birth until >36+0 weeks can be considered to improve fetal outcomes. Further studies are needed to investigate this fully.
- Published
- 2021