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
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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.
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