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J Matern Fetal Neonatal Med. 2017 Jun;30(12):1423-1427. doi: 10.1080/14767058.2016.1216099. Epub 2016 Aug 18.

Invasive placental disease: the impact of a multi-disciplinary team approach to management.

Author information

1
a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA and.
2
b Department of Obstetrics and Gynecology , University of South Florida, Morsani College of Medicine , Tampa , FL , USA.

Abstract

PURPOSE:

To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD).

MATERIALS AND METHODS:

This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started.

RESULTS:

There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260 min versus 181 min, p = 0.0001), less blood loss (1200 mL versus 2500 mL, p = 0.009), less administration of blood products (47.4% versus 85.7%, p = 0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57 mmHg versus 48 mmHg, p = 0.002, when compared to the No-MDT (n = 28) approach. No differences were found for other outcomes.

CONCLUSION:

Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.

KEYWORDS:

Invasive placenta; accreta; multidisciplinary team; perinatal outcomes

PMID:
27534584
DOI:
10.1080/14767058.2016.1216099
[Indexed for MEDLINE]

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