Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, AR, USA.
The College of Medicine, University of Arkansas for the Medical Sciences, Little Rock, AR, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5964-5969. doi: 10.1080/14767058.2021.1903425. Epub 2021 Mar 26.
To compare maternal and neonatal outcomes following the development of a multidisciplinary care team for the management of pregnancies complicated by placenta accreta spectrum (PAS) in a rural state.
This is a retrospective cohort study evaluating pregnancies managed before PAS team care management formation (2010-2015) and after (2016-2020) in a university medical center. Maternal and neonatal outcomes were analyzed. Patients were grouped by delivery date to either before or after dedicated PAS team formation. Maternal and neonatal outcomes were analyzed. Frequencies and percentages were reported for categorical measures while means and standard deviations were computed for continuous measures. Wilcoxon rank-sum test was used for continuous variables while Chi-square or Fisher's exact was used for categorical measures.
There were 82 patients with PAS managed at our institution (29 in Pre-PAS team group and 53 in Post-PAS team group). The number of units of packed red blood cells (PRBCS) transfused intraoperatively was significantly higher in the Pre-PAS care team group (6.52 vs. 3.26, = .0057). The total number of units PRBCS transfused (9.93 vs. 3.51, = .0014) and total number of cryoprecipitate transfused (0.77 vs. 0.08, = .0225) during the entire hospital stay were increased in the Pre-PAS team group. Median neonatal 1 min and 5 min APGAR scores were lower in the Pre-PAS care team group (2 vs 6 at 1 min, = .0035; 6 vs. 7at 5 min, = .0301).
Management of PAS by a dedicated, multidisciplinary team results in less blood transfusion requirements and improved maternal and neonatal outcomes.
比较在农村州成立多学科医疗团队管理胎盘植入谱系疾病（PAS）妊娠后母婴结局。
这是一项回顾性队列研究，评估了在大学医疗中心成立 PAS 护理团队前（2010-2015 年）和成立后（2016-2020 年）管理的妊娠情况。分析了母婴结局。根据分娩日期将患者分为 PAS 团队成立前组和成立后组。分析了母婴结局。对分类变量采用频率和百分比表示，对连续变量采用平均值和标准差表示。连续变量采用 Wilcoxon 秩和检验，分类变量采用卡方检验或 Fisher 精确检验。
在我院共收治 PAS 患者 82 例（Pre-PAS 护理团队组 29 例，Post-PAS 护理团队组 53 例）。Pre-PAS 护理团队组术中输注的红细胞单位数（PRBC）明显高于 PAS 护理团队组（6.52 vs. 3.26，=0.0057）。整个住院期间 PRBC 总输注量（9.93 vs. 3.51，=0.0014）和冷沉淀总输注量（0.77 vs. 0.08，=0.0225）均增加了。Pre-PAS 护理团队组新生儿 1 分钟和 5 分钟的 APGAR 评分中位数较低（1 分钟时为 2 分和 6 分，=0.0035；5 分钟时为 6 分和 7 分，=0.0301）。
由专门的多学科团队管理 PAS 可减少输血需求，并改善母婴结局。
