BACKGROUND
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.
Objectives
We aimed to investigate clinical compliance with the recommended delivery timing window
for placenta accreta spectrum and its impact on maternal and neonatal outcomes.
STUDY DESIGN
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.
RESULTS
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.
CONCLUSION
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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & Gynecology MFMAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998–2011.J Matern Fetal Neonatal Med. 2016; 29: 1077-1082
- American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Cahill AG, et al. Placenta accreta spectrum.Am J Obstet Gynecol. 2018; 219: B2-16
- A comparison of recent guidelines in the diagnosis and management of placenta accreta spectrum disorders.Best Pract Res Clin Obstet Gynaecol. 2021; 72: 102-116
- Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum: a multinational database study.Acta Obstet Gynecol Scand. 2021; 100: 41-49
- Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team.Am J Obstet Gynecol. 2019; 221: 337.e1-337.e5
- Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta.Obstet Gynecol. 2018; 131: 234-241
- Center of excellence for placenta accreta.Am J Obstet Gynecol. 2015; 212: 561-568
- The role of centers of excellence with multidisciplinary teams in the management of abnormal invasive placenta.Clin Obstet Gynecol. 2018; 61: 841-850
- Placenta accreta spectrum.NeoReviews. 2021; 22: e722-e733
- Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach.Am J Obstet Gynecol. 2015; 212: 218.e1-218.e9
- Placenta accreta spectrum disorder: updates on anesthetic and surgical management strategies.Int J Obstet Anesth. 2021; 46102975
- Risk factors for unscheduled delivery in patients with placenta accreta.Am J Obstet Gynecol. 2014; 210: 241.e1-241.e6
- Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta.Obstet Gynecol. 2010; 116: 835-842
- Characteristics of individuals with placenta previa and results of “expectant management.Am J Obstet Gynecol. 1978; 132: 180-191
- Placenta previa: aggressive expectant management.Am J Obstet Gynecol. 1984; 150: 15-22
- The Society for Pediatric Pathology Task Force grading system for placenta accreta spectrum and its correlation with clinical outcomes.Am J Obstet Gynecol. 2022; 226 (720.e1–6)
- FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: nonconservative surgical management.Int J Gynaecol Obstet. 2018; 140: 281-290
- Patient selection for later delivery timing with suspected previa-accreta.Acta Obstet Gynecol Scand. 2017; 96: 1021-1028
- Placenta previa, placenta accreta, and vasa previa.Obstet Gynecol. 2006; 107: 927-941
- The diagnosis and management of morbidly adherent placenta.Semin Perinatol. 2018; 42: 49-58
- Timing of surgery for placenta previa with suspected abnormally invasive placentation: a test of team competency?.Acta Obstet Gynecol Scand. 2017; 96: 1029
- Royal College of Obstetricians and Gynaecologists. Placenta praevia and placenta accreta: diagnosis and management: Green-top Guideline No. 27a.BJOG. 2019; 126: e1-48
- Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta.Am J Obstet Gynecol. 2019; 220: 511-526
- 383-screening, diagnosis, and management of placenta accreta spectrum disorders.J Obstet Gynaecol Can. 2019; 41: 1035-1049
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. guidelines for placenta accreta. Available at:https://ranzcog.edu.au/wp-content/uploads/2022/05/Placenta-Accreta.pdf.
- Diagnosis of placenta accreta spectrum in high-risk women using ultrasonography or magnetic resonance imaging: systematic review to compare accuracy of tests.Ultrasound Obstet Gynecol. 2022; 59: 428-436
- Effectiveness of ultrasound screening for a placenta accreta spectrum using standard ultrasound criteria in a secondary care setting.Fetal Diagn Ther. 2022; 49: 52-59
Article Info
Publication History
Published online: August 14, 2022
Accepted:
August 10,
2022
Received:
August 5,
2022
Footnotes
The authors report no conflict of interest.
No funding was received for this work.
Cite this article as: Salmanian B, Einerson BD, Carusi DA, et al. Timing of delivery for placenta accreta spectrum: the Pan-American Society for the Placenta Accreta Spectrum experience. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
