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Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization: the PASTIME protocol.

Dora J Melber1, Zachary T Berman2, Marni B Jacobs1

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA.

American Journal of Obstetrics and Gynecology
|July 10, 2021
PubMed
Summary
This summary is machine-generated.

A new multidisciplinary protocol for placenta accreta spectrum (PAS) involving embolization significantly reduced blood transfusions and blood loss. This surgical approach for PAS offers improved maternal outcomes and warrants consideration at specialized centers.

Keywords:
arterial embolizationblood lossblood transfusioncesarean hysterectomyinterventional radiologyplacenta accreta spectrumpostpartum hemorrhagepregnancy

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Area of Science:

  • Obstetrics and Gynecology
  • Interventional Radiology
  • Surgical Oncology

Background:

  • Multidisciplinary care is crucial for placenta accreta spectrum (PAS) cases, yet protocols vary.
  • Increasing PAS experience necessitates evaluating new surgical techniques and protocols for improved maternal outcomes.
  • Standardizing multidisciplinary collaboration is key for managing complex PAS cases.

Purpose of the Study:

  • To assess a novel multidisciplinary protocol for placenta accreta spectrum (PAS) treatment.
  • The protocol integrates cesarean delivery, multivessel uterine embolization, and hysterectomy in a single procedure.
  • Evaluation was conducted within a hybrid operative suite setting.

Main Methods:

  • A matched pre-post study design compared PAS cases before (2010-2017) and after (2018-2021) protocol implementation.
  • The new protocol involved cesarean delivery, multivessel uterine embolization, and hysterectomy.
  • Historical controls received internal iliac artery balloon placement; cases were matched by PAS severity and surgical urgency.

Main Results:

  • The new protocol group (15 cases) showed significantly less estimated blood loss (750 mL vs. 1750 mL) compared to the historical group (30 cases).
  • While not statistically significant (P=.11), fewer cases in the new protocol group required blood transfusions (33.3% vs. 63.3%).
  • No intraoperative deaths from hemorrhagic shock occurred with the new protocol, unlike two in the historical group.

Conclusions:

  • The multidisciplinary pathway, including single-surgery with multivessel uterine embolization, reduces transfusion needs and blood loss without increasing complications.
  • The Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization protocol is a definitive surgical method.
  • This protocol should be considered by centers specializing in placenta accreta spectrum treatment.