Invasive placental disease: the impact of a multi-disciplinary team approach to management.
PURPOSE: To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD).
MATERIALS AND METHODS: This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started.
RESULTS: There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260 min versus 181 min, p = 0.0001), less blood loss (1200 mL versus 2500 mL, p = 0.009), less administration of blood products (47.4% versus 85.7%, p = 0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57 mmHg versus 48 mmHg, p = 0.002, when compared to the No-MDT (n = 28) approach. No differences were found for other outcomes.
CONCLUSION: Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.
Published In/Presented At
Smulian, J. C., Pascual, A., Hesham, H., Qureshey, E., Bijoy Thomas, M., Depuy, A. M., & ... Scorza, W. E. (2016). Invasive placental disease: the impact of a multi-disciplinary team approach to management. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The Federation Of Asia And Oceania Perinatal Societies, The International Society Of Perinatal Obstetricians, 30(12): 1423-1427
Obstetrics and Gynecology
Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology Faculty