Multidisciplinary Management of Invasive Placenta Previa

• Published in: Journal of obstetrics and gynaecology Canada Vol. 35; no. 5; pp. 417 - 425
• Main Authors: Walker, Melissa G., MSc, Allen, Lisa, MD, FRCSC, Windrim, Rory C., MB, FRCSC, Kachura, John, MD, FRCPC, Pollard, Lindsay, RN, Pantazi, Sophia, MD, FRCPC, Keating, Sarah, MD, FRCPC, Carvalho, Jose C.A., MD, PhD, Kingdom, John C.P., MD, FRCSC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-05-2013
• Subjects: Adult; bladder injury; Disease Management; Female; hemorrhage; Humans; Invasive placentation; Obstetrics and Gynecology; Patient Care Planning; Patient Care Team - organization & administration; Patient Care Team - utilization; placenta increta; placenta percreta; placenta previa; Placenta Previa - diagnosis; Placenta Previa - therapy; Pregnancy; severe obstetric morbidity; Severity of Illness Index; Young Adult; Invasive placentation; severe obstetric morbidity; placenta percreta; placenta previa; placenta increta; bladder injury; hemorrhage; invasive placentation
• ISSN: 1701-2163
• DOI: 10.1016/S1701-2163(15)30932-4

Abstract Objective To assess the effectiveness of a multidisciplinary team approach to reduce severe maternal morbidity in women with invasive placenta previa. Methods We conducted a prospective study of 33 women with placenta previa and increta-percreta (diagnosed by ultrasound and/or magnetic resonance imaging) delivering at Mount Sinai Hospital, Toronto, following the introduction in January 2008 of a team-based approach to women with this condition. We included women who delivered by June 2012. We reviewed antenatal outpatient and inpatient records for use of six pre-defined team components by the attending staff obstetrician: (1) antenatal maternal–fetal medicine consultation, (2) surgical gynaecology consultation, (3) antenatal MRI, (4) interventional radiology consultation and preoperative placement of balloon catheters in the anterior divisions of the internal iliac arteries, (5) pre-planned surgical date, and (6) surgery performed by members of the invasive placenta surgical team. Antenatal course, delivery, and postpartum details were recorded to derive a five-point composite severe maternal morbidity score based on the presence or absence of: (1) ICU admission following delivery, (2) transfusion > 2 units of blood, (3) general anaesthesia start or conversion, (4) operating time in highest quartile (> 125 minutes), and (5) significant postoperative complications (readmission, prolonged postpartum stay, and/or pulmonary embolism). Results All 33 women survived during this time period. Two thirds (22/33) had either five or six of the six components of multidisciplinary care. Increasing use of multidisciplinary team components was associated with a significant reduction in composite morbidity ( R2 = 0.228, P = 0.005). Conclusion Team-based assessment and management of women with invasive placenta previa is likely to improve maternal outcomes and should be encouraged on a regional basis.