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Published on: September 10, 2018
Standardized Criteria for Measuring Severe Maternal Morbidity in Placenta Accreta Spectrum Disorder
Brett D Einerson1, Sarah Rae Easter, Daniela Carusi
1Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesiology, University of California, San Francisco, San Francisco, and the Division of Maternal-Fetal Medicine, Stanford University, Stanford, California; the Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, New York; the EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom; the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; the Department of Obstetrics and Gynaecology, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada; and the Division of Maternal-Fetal Medicine, University of Virginia, Charlottesville, Virginia.
Standardized criteria for severe maternal morbidity and mortality (SMM) in placenta accreta spectrum (PAS) are proposed. This aims to improve research by distinguishing complications from interventions, aiding evidence-based care.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health Research
- Clinical Trial Methodology
Background:
- Placenta accreta spectrum (PAS) is linked to severe maternal morbidity and mortality.
- Inconsistent outcome reporting in PAS studies hinders comparison of management strategies.
- Existing severe maternal morbidity (SMM) definitions misclassify expected interventions as complications.
Purpose of the Study:
- To propose standardized criteria for measuring SMM and mortality in PAS.
- To differentiate true complications from anticipated interventions in PAS care.
- To facilitate meaningful comparisons of management approaches in PAS research.
Main Methods:
- Collaborative expert consensus was used to identify key outcomes.
- Developed a composite primary outcome for SMM in PAS.
- Defined criteria to exclude institutional protocols and focus on unexpected events.
Main Results:
- A proposed SMM for PAS definition includes maternal death, massive transfusion, reoperation, organ injury, prolonged ventilation, and other critical events.
- The definition distinguishes unexpected complications from routine interventions like hysterectomy or blood transfusions.
- The composite outcome uses objective criteria to minimize interpretation variability.
Conclusions:
- Standardized SMM reporting for PAS is crucial for advancing research.
- The proposed definition will enable evidence-based guideline generation.
- Implementing standardized outcomes will ultimately improve patient care for PAS.
