Bartels Helena C, Fox Karin A, Aryananda Rozi Aditya, Terlizzi Kristen, Cooney Naomi, Nieto-Calvache Albaro José, Lalor Joan G, Brennan Donal J
Department of Obstetrics and Gynecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
Division of Maternal-Fetal Medicine, Department of OB-GYN, University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
Int J Gynaecol Obstet. 2025 Jul 1. doi: 10.1002/ijgo.70345.
Previously, we made recommendations for "family-centered care" for patients with placenta accreta spectrum (PAS). This study explored patients' experience of their care and how often these recommendations are utilized. Furthermore, we explored whether these recommendations are valued by healthcare providers and identify barriers to implementation.
This study consists of two surveys; one for patients with a history of PAS and a second survey for healthcare providers involved in PAS care. Surveys were circulated over an 8-week period between September and October 2024. Four overarching recommendations were investigated as follows; preparation for birth, supportive care, education of healthcare providers and postpartum care. Quantitative and qualitative data were obtained; content analysis was performed to identify themes from the patient and healthcare provider experiences.
A total of 155 patients responded to the online survey. While some felt well prepared for the birth (96/155, 63%), most felt frustrated by the lack of treatment options and preparatory resources (n = 122/155, 78%). Less than half of patients were offered mental health referrals (n = 69/155, 44%), although when offered they were positively received. Only 40% (n = 62/155) of patients were offered specialist postpartum care. From the healthcare provider survey, which had 89 responses, possible barriers identified by healthcare providers to offer such support were cost, lack of insurance coverage and geographical distance. Qualitative content analysis revealed that patients strongly expressed a need for counseling, physical health support, and specialist postpartum care.
Previously published recommendations are strongly desired by patients, with positive experiences where these are offered. Healthcare providers acknowledge and value the need for supportive care, with barriers to implementation including cost and limited resources. We suggest practical, low-cost measures to overcome these gaps.
此前，我们针对胎盘植入谱系疾病（PAS）患者的“以家庭为中心的护理”提出了建议。本研究探讨了患者对其护理的体验以及这些建议的使用频率。此外，我们还探讨了这些建议是否受到医疗服务提供者的重视，并确定了实施过程中的障碍。
本研究包括两项调查；一项针对有PAS病史的患者，另一项针对参与PAS护理的医疗服务提供者。调查于2024年9月至10月的8周内进行。对以下四项总体建议进行了调查：分娩准备、支持性护理、医疗服务提供者教育和产后护理。获取了定量和定性数据；进行了内容分析，以确定患者和医疗服务提供者体验中的主题。
共有155名患者回复了在线调查。虽然一些人对分娩准备充分（96/155，63%），但大多数人因缺乏治疗选择和准备资源而感到沮丧（n = 122/155，78%）。不到一半的患者获得了心理健康转诊（n = 69/155，44%），不过当提供时，患者对此反应积极。只有40%（n = 62/155）的患者获得了专科产后护理。在有89份回复的医疗服务提供者调查中，医疗服务提供者确定的提供此类支持的可能障碍包括成本、缺乏保险覆盖和地理距离。定性内容分析显示，患者强烈表达了对咨询、身体健康支持和专科产后护理的需求。
患者强烈希望获得此前发布的建议，当提供这些建议时，患者有积极的体验。医疗服务提供者认可并重视支持性护理的必要性，实施过程中的障碍包括成本和资源有限。我们建议采取切实可行的低成本措施来弥补这些差距。
