Multidisciplinary protocol and outcomes in placenta accreta spectrum: a 12 year cohort study

Area of Science:

• Obstetrics and Gynecology
• Surgical Management
• Patient Safety

Background:

• Placenta accreta spectrum (PAS) is a high-risk obstetric condition linked to hemorrhage, urologic injury, and hysterectomy.
• Increasing cesarean delivery rates correlate with rising PAS prevalence.
• Varied surgical approaches and limited multidisciplinary input may worsen maternal outcomes.

Purpose of the Study:

• To assess if a multidisciplinary team (MDT) protocol for PAS improves perioperative outcomes.
• To evaluate the impact of standardized care on surgical complications and patient recovery.

Main Methods:

• Retrospective cohort study of 417 women with PAS (2011-2022).
• Comparison of outcomes before (n=309) and after (n=108) implementing a structured MDT protocol in 2019.
• MDT protocol included standardized imaging, preoperative conferences, ureteral catheter placement, and on-site urologic support.

Main Results:

• MDT care was associated with significantly lower odds of urologic injury, surgical complications, transfusion, and hysterectomy.
• Adjusted estimated blood loss decreased by 260 mL, and length of hospital stay was reduced by 0.9 days.
• Findings were consistent in sensitivity analyses.

Conclusions:

• Implementation of an MDT protocol significantly reduced perioperative morbidity in PAS surgery.
• Multidisciplinary management represents a safer strategy for complex PAS cases.
• Standardized protocols enhance outcomes for high-risk obstetric conditions.