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Objective: To describe the evolution and evaluation of protocol-based multidisciplinary quality improvement (QI) in women undergoing cesarean hysterectomy for radiologically suspected and pathologically confirmed placenta accreta spectrum (PAS) disorders., Methods: A single-center, retrospective cohort study was conducted of all patients undergoing cesarean hysterectomy for PAS disorders between March 2009 and June 2018. Two distinct periods were defined to compare outcomes: 2009-2011 (initial period) and 2017-2018 (current period). Primary outcomes included blood loss and administration of blood products. Secondary outcomes included perioperative levels of hemoglobin, adverse events and complications, time to mobilization, and length of hospitalization., Results: Among the 105 consecutive patients identified, there were 26 in the initial period and 32 in the current period. With the implementation of all QI care bundles, median estimated surgical blood loss halved from 2000 ml in the initial period to 1000 ml in the current period, and fewer patients required allogenic blood transfusion (61.5% vs 25%). Patients in the current period demonstrated improved postoperative levels of hemoglobin compared to those in the initial period (101 g/L vs 89 g/L) and had a shorter median postoperative hospital stay (3 days vs 5 days)., Conclusion: These results support the implementation of a multifaceted QI and patient care initiative for women with PAS disorders., (© 2021 International Federation of Gynecology and Obstetrics.)

Purpose: To characterize the magnetic susceptibility and relaxation times (T 1 and T 2 ) of fetal blood at 3 T as a function of the hematocrit (Hct) and oxygen saturation (sO 2 )., Methods: Susceptibility and relaxometry measurements were performed on cord blood specimens (N = 90, derived from six caesarean deliveries) with a range of hematocrits and oxygen saturations (0.09 < Hct < 0.82, 7 < sO 2  < 100%). To obtain simple, analytic relationships between MRI properties and blood properties, data were fit to established two-compartment (plasma and erythrocytes) models., Results: Two-compartment models effectively described the cord blood data. The root-mean-squared deviation between the model and the data was 6.3, 10.3, and 1.3% for fits to T 1 , T 2 , and susceptibility measurements. Relaxometry data and estimated T 1 and T 2 model parameters were generally consistent with those reported in cord blood at 1.5 T and comparable to published values for adult blood. Notably, the measured value of Δχ deo , the susceptibility difference between fully oxygenated (sO 2  = 100%) and deoxygenated (sO 2  = 0) cord blood was approximately 20% lower than the established adult blood value (Δχ deo,cord  = 2.64 ppm, Δχ deo,adult  = 3.4 ppm)., Conclusions: The described models and associated parameter values can be used to inform acquisition parameters, and interpret fetal/neonatal blood susceptibility measurements and relaxometry data acquired at 3 T with respect to hematocrit and sO 2 . Magn Reson Med 79:3194-3206, 2018. © 2017 International Society for Magnetic Resonance in Medicine., (© 2017 International Society for Magnetic Resonance in Medicine.)