Placenta accreta spectrum – variations in clinical practice and maternal morbidity between the UK and France: a population‐based comparative study. (29th April 2022)

• Record Type: Journal Article
• Authors: McCall, Stephen J.; Deneux‐Tharaux, Catherine; Sentilhes, Loïc; Ramakrishnan, Rema; Collins, Sally L.; Seco, Aurélien; Kurinczuk, Jennifer J.; Knight, Marian; Kayem, Gilles
• Is Part Of: BJOG. Volume 129:Number 10(2022)
• Page Start: 1676
• Page End: 1685
• Publication Date: 2022-04-29
• Subjects: conservative management -- haemorrhage -- hysterectomy -- management -- placenta accreta spectrum; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.17169
• Languages: English
• ISSNs: 1470-0328

Abstract

Abstract: Objective: To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK. Design: Two population‐based cohorts. Setting: All obstetrician‐led hospitals in the UK and maternity hospitals in eight French regions. Population: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK. Methods: The management and outcomes of women with PAS were compared between the UK and France. Main outcome measures: Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs. Results: The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus‐preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7–6.5 l), compared with 1 l (IQR 0.5–2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: '24 hour' has been changed to 'total' in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage. Conclusions: The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine‐conserving approach and more women in the UK undergoing caesarean hysterectomy. A life‐threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Tweetable abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Tweetable abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Linked article : This article is commented on by Amarnath Bhide, pp. 1686 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17170 .