Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina.
Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina.
Am J Perinatol. 2022 Oct;29(14):1503-1513. doi: 10.1055/s-0042-1754321. Epub 2022 Aug 16.
This study compares the number of units of red blood cells (RBCs) transfused in patients with placenta accreta spectrum (PAS) treated with or without a multidisciplinary algorithm that includes placental uterine arterial embolization (P-UAE) and selective use of either immediate or delayed hysterectomy.
This is a retrospective study of deliveries conducted at a tertiary care hospital from 2001 to 2018 with pathology-confirmed PAS. Those with previable pregnancies or microinvasive histology were excluded. To improve the equity of comparison, analyses were made separately among scheduled and unscheduled cases, therefore patients were assigned to one of four cohorts as follows: (1) scheduled/per-algorithm, (2) scheduled/off-algorithm, (3) unscheduled/per-algorithm, or (4) unscheduled/off-algorithm. Primary outcomes included RBCs transfused and estimated blood loss (EBL). Secondary outcomes included perioperative complications and disposition.
Overall, 95 patients were identified, with 87 patients meeting inclusion criteria: 36 treated per-algorithm (30 scheduled and 6 unscheduled) and 51 off-algorithm patients (24 scheduled and 27 unscheduled). Among scheduled deliveries, 9 (30.0%) patients treated per-algorithm received RBCs compared with 20 (83.3%) patients treated off-algorithm ( < 0.01), with a median (interquartile range [IQR]) of 3.0 (2.0, 4.0) and 6.0 (2.5, 7.5) units transfused ( = 0.13), respectively. Among unscheduled deliveries, 5 (83.3%) per-algorithm patients were transfused RBCs compared with 25 (92.6%) off-algorithm patients ( = 0.47) with a median (IQR) of 4.0 (2.0, 6.0) and 8.0 (3.0, 10.0) units transfused ( = 0.47), respectively. Perioperative complications were similar between cohorts.
A multidisciplinary algorithm including P-UAE and selective use of delayed hysterectomy is associated with a lower rate of blood transfusion in scheduled but not unscheduled cases.
· An algorithm with delayed hysterectomy had less transfusion in scheduled, but not unscheduled, cases.. · Over time, more cases were managed per algorithm; among scheduled cases, the transfusion rate and volume transfused decreased.. · There were similar transfusion outcomes among off-algorithm cases, regardless if delivery was scheduled..
本研究比较了胎盘部位滋养细胞肿瘤（PAS）患者接受或不接受多学科算法治疗时输注的红细胞（RBC）单位数，该算法包括胎盘子宫动脉栓塞术（P-UAE）和即刻或延迟子宫切除术的选择性使用。
这是一项回顾性研究，在 2001 年至 2018 年期间在一家三级保健医院进行，病理证实为 PAS。排除了有存活胎儿或微侵袭性组织学的患者。为了提高可比性，分别对计划分娩和非计划分娩的患者进行分析，因此患者被分为以下四组之一：（1）计划/按算法，（2）计划/不按算法，（3）非计划/按算法，或（4）非计划/不按算法。主要结局包括输注的 RBC 和估计失血量（EBL）。次要结局包括围手术期并发症和处置。
总体而言，共确定了 95 例患者，其中 87 例符合纳入标准：36 例按算法治疗（30 例计划分娩和 6 例非计划分娩）和 51 例不按算法治疗（24 例计划分娩和 27 例非计划分娩）。在计划分娩中，9（30.0%）例按算法治疗的患者接受 RBC 治疗，而 20（83.3%）例按算法治疗的患者接受 RBC 治疗（<0.01），中位数（四分位距[IQR]）分别为 3.0（2.0，4.0）和 6.0（2.5，7.5）单位（=0.13）。在非计划分娩中，5（83.3%）例按算法治疗的患者接受 RBC 治疗，而 25（92.6%）例不按算法治疗的患者接受 RBC 治疗（=0.47），中位数（IQR）分别为 4.0（2.0，6.0）和 8.0（3.0，10.0）单位（=0.47）。各队列之间的围手术期并发症相似。
包括 P-UAE 和选择性使用延迟性子宫切除术的多学科算法与计划分娩时输血率较低相关，但与非计划分娩时无关。
· 延迟性子宫切除术的算法在计划分娩中，而不是非计划分娩中，输血较少。· 随着时间的推移，更多的病例按算法治疗；在计划分娩中，输血率和输血量减少。· 非按算法治疗的病例输血结果相似，无论分娩是否计划。
