Invasive placental disease: the impact of a multi-disciplinary team approach to management. (18th June 2017)

• Record Type: Journal Article
• Authors: Smulian, John C.; Pascual, Ana-Liza; Hesham, Helai; Qureshey, Emma; Bijoy Thomas, M.; Depuy, Amy M.; Flicker, Amanda B.; Scorza, William E.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 30:Number 12(2017)
• Page Start: 1423
• Page End: 1427
• Publication Date: 2017-06-18
• Subjects: Invasive placenta -- accreta -- multidisciplinary team -- perinatal outcomes; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2016.1216099
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose : To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD). Materials and 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. Conclusion : 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.