Albaro José Nieto1,2,3, María Paula Echavarría1,2,3, Javier Andrés Carvajal1,2,3, Adriana Messa1,2,3, Juan Manuel Burgos1,2,3, Carlos Ordoñez4,3, Juan Pablo Benavidez1,3, Mauricio Mejía5,3, Leidy López6,3, Paula Andrea Fernández7, María Fernanda Escobar1,2,3. 1. Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia. 2. Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia. 3. Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia. 4. Department of Surgery, Fundación Valle del Lili, Cali, Colombia. 5. Department of Radiology, Fundación Valle del Lili, Cali, Colombia. 6. Department of Anesthesiology, Fundación Valle del Lili, Cali, Colombia. 7. Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.
Abstract
Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development of expertize in all obstetric centers. We evaluated the results obtained from a multidisciplinary approach in patients with PA in a Latin American hospital. Methods: The study included patients with prenatal suspicion or intraoperative diagnosis of PA, before and after initiating a set of interdisciplinary and institutional interventions, with the aim of achieving better outcomes. Results: From December 2011 to December 2017, 62 patients with prenatally or intraoperatively suspected PA underwent surgery. The first 30 women (Group A), admitted until April 2016 and before any changes in the management protocol, had a longer hospital stay and surgery time, higher newborn hospitalization, and greater use of general anesthesia, compared to the 20 patients from Group B, who were admitted during the last 20 months of the observation period. A total of 12 women with late and intraoperative diagnosis, under no institutional protocol, showed greater blood loss and more frequent red blood cell transfusions.Conclusions: The expertize of the multidisciplinary team responsible for managing women with PA is associated with better clinical outcomes.
Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development of expertize in all obstetric centers. We evaluated the results obtained from a multidisciplinary approach in patients with PA in a Latin American hospital. Methods: The study included patients with prenatal suspicion or intraoperative diagnosis of PA, before and after initiating a set of interdisciplinary and institutional interventions, with the aim of achieving better outcomes. Results: From December 2011 to December 2017, 62 patients with prenatally or intraoperatively suspected PA underwent surgery. The first 30 women (Group A), admitted until April 2016 and before any changes in the management protocol, had a longer hospital stay and surgery time, higher newborn hospitalization, and greater use of general anesthesia, compared to the 20 patients from Group B, who were admitted during the last 20 months of the observation period. A total of 12 women with late and intraoperative diagnosis, under no institutional protocol, showed greater blood loss and more frequent red blood cell transfusions.Conclusions: The expertize of the multidisciplinary team responsible for managing women with PA is associated with better clinical outcomes.