Placenta accreta spectrum disorders: A retrospective continuous audit of clinical outcomes of 82 cases over 18 years in a large outer London associated teaching hospital

Abstract

AbstractObjectiveTo analyse and describe the clinical outcomes for the women with placenta accreta spectrum (PAS) disorders managed in our Trust over the last 18 years.DesignHospital‐based retrospective continuous audit.SettingContinuous audit of the women diagnosed with PAS between 2005 and 2023.PopulationLarge outer London teaching hospital.MethodsAll women with low‐lying placenta on a previous caesarean scar were screened during their anomaly scan. Those with suspected PAS were referred to foetal medicine and once confirmed, managed using a multidisciplinary team approach.Main Outcome MeasuresTime of diagnosis, risk factors, timing of and gestation at delivery, type of surgical procedure, length of stay, intensive therapy unit admission, blood transfusion requirements, use of cell salvage, haemostatic techniques, histology, in‐utero transfer rate, need for emergency delivery and complications.ResultsOf the 82 women, 61% were nonwhite and 76% overweight or obese. Thirty‐four percent occurred in women with one previous caesarean. The number managed each year increased, with 39% occurring since 2018. Twenty‐two percent were transferred from other Trusts. Eighty‐four percent delivered >32 weeks gestation with only two women delivering live births <28 weeks. Eighty‐three percent delivered by planned caesarean. Complication rates were low overall, haemorrhage >3 L occurred in 35%. Since 2018, 72% had excision and these cases had better surgical outcomes and fewer complications.ConclusionsOur data demonstrates that our cohort of women are a high‐risk population but despite this, our results are favourable and demonstrate a move to excision surgery with associated reduced morbidity, low rate of complications, a short hospital stay and very low rates of extremely premature deliveries.