Salmanian Bahram, Einerson Brett D, Carusi Daniela A, Shainker Scott A, Nieto-Calvache Albaro J, Shrivastava Vineet K, Subramaniam Akila, Zuckerwise Lisa C, Lyell Deirdre J, Khandelwal Meena, Fitzgerald Garrett D, Hessami Kamran, Fox Karin A, Silver Robert M, Shamshirsaz Alireza A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (Drs Salmanian, Hessami, Fox, and Shamshirsaz).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah Health, Salt Lake City, UT (Drs Einerson and Silver).
Am J Obstet Gynecol MFM. 2022 Nov;4(6):100718. doi: 10.1016/j.ajogmf.2022.100718. Epub 2022 Aug 14.
The Society for Maternal-Fetal Medicine recommends cesarean delivery with potential hysterectomy scheduled in the late preterm period between 34 0/7 and 35 6/7 weeks of gestation for prenatally suspected placenta accreta spectrum.
We aimed to investigate clinical compliance with the recommended delivery timing window for placenta accreta spectrum and its impact on maternal and neonatal outcomes.
We performed a retrospective multicenter review of data from referral centers within the Pan-American Society for Placenta Accreta Spectrum. Patients with placenta accreta spectrum with both antenatal diagnosis and confirmed histopathologic findings were included. We investigated adherence to the Society for Maternal-Fetal Medicine-recommended gestational age window for delivery, and compliance was further stratified by scheduled and unscheduled delivery. We compared the outcomes for patients with scheduled delivery within vs immediately 2 weeks outside the recommended window.
Among 744 patients with a prenatal diagnosis of placenta accreta spectrum and placental histopathologic confirmation, 488 (66%) had scheduled delivery. Among all prenatally diagnosed placenta accreta spectrum patients, 252 (39%) delivered within the recommended window of 34 0/7 and 35 6/7 weeks gestation. For the subgroup of patients who underwent scheduled delivery (n=426), 209 (49%) had delivery in this window, 120 (28%) delivered before 34 weeks, and 97 (23%) delivered at or later than 36 weeks. In the patients with scheduled delivery, 27% of placenta accreta spectrum patients with accreta delivered in the 2 weeks immediately after the recommended window (36 0/7-37 6/7 weeks), and 22% of placenta accreta spectrum pregnancies with increta/percreta delivered in the 2 weeks immediately before the recommended delivery (32 0/7-33 6/7 weeks). The maternal outcomes among those who delivered within the recommended range vs those delivering 2 weeks before and after the recommended range were similar, regardless of placenta accreta spectrum severity.
Less than half of placenta accreta spectrum patients had scheduled delivery within the recommended gestational age of 34 0/7 to 35 6/7 weeks. The reasons for deviation from recommendations and the risks and benefits of individualized timing of delivery on the basis of risk factors and predicted outcomes warrant further investigation.
母胎医学协会建议，对于产前疑似胎盘植入谱系疾病的患者，在妊娠34 0/7至35 6/7周的晚期早产阶段进行剖宫产并可能同时进行子宫切除术。
我们旨在调查临床对胎盘植入谱系疾病推荐分娩时间窗的依从性及其对母婴结局的影响。
我们对泛美胎盘植入谱系协会转诊中心的数据进行了回顾性多中心分析。纳入有胎盘植入谱系疾病且有产前诊断和组织病理学确诊结果的患者。我们调查了对母胎医学协会推荐的分娩孕周窗的依从性，并按计划分娩和非计划分娩进一步分层。我们比较了在推荐窗内进行计划分娩的患者与在推荐窗外立即分娩2周的患者的结局。
在744例产前诊断为胎盘植入谱系疾病且有胎盘组织病理学确诊的患者中，488例（66%）进行了计划分娩。在所有产前诊断为胎盘植入谱系疾病的患者中，252例（39%）在推荐的妊娠34 0/7至35 6/7周窗内分娩。对于进行计划分娩的亚组患者（n = 426），209例（49%）在此窗内分娩，120例（28%）在34周前分娩，97例（23%）在36周及以后分娩。在计划分娩的患者中，27%的胎盘植入谱系疾病伴植入患者在推荐窗后立即的2周内（36 0/7至37 6/7周）分娩，22%的胎盘植入谱系疾病伴侵入性/穿透性植入妊娠在推荐分娩前立即的2周内（32 0/7至33 6/7周）分娩。无论胎盘植入谱系疾病的严重程度如何，在推荐范围内分娩的患者与在推荐范围前后2周分娩的患者的母体结局相似。
不到一半的胎盘植入谱系疾病患者在推荐的34 0/7至35 6/7周胎龄内进行了计划分娩。偏离推荐的原因以及基于风险因素和预测结局进行个体化分娩时间的风险和益处值得进一步研究。
