Placenta Accreta Spectrum (PAS) is associated with serious risks to the health and life of both the mother and baby. In order to minimise these risks and ensure women received the highest standard of care, a multi-disciplinary team (MDT) was established at the National Maternity Hospital (NMH) in June 2017. The MDT provides specialist care for all women with a suspected or confirmed diagnosis of PAS who are attending the NMH or are referred from other units.
The PAS multidisciplinary meeting is held monthly with various specialists in attendance including fetal maternal-medicine, gynae-oncology, radiology and anaesthesiologists. The meeting allows for a team discussion of all women who have a suspected diagnosis PAS. An individualised care plan is put in place and a lead consultant assigned to oversee the care of the woman. A plan for elective delivery is made, usually between 34-36 weeks, with a contingency plan in case an emergency delivery is necessary.
In order to assess whether the implementation of the MDT service has improved outcomes for mothers with a diagnosis of PAS, all women managed in the first two years of the MDT (2017-2019) were compared to women with PAS cared for at the NMH in the 10 years (2006-2016) before MDT care. The study included 60 women, 32 of whom were cared for before the MDT was established and 28 women managed as part of the MDT. The study had a number of key findings.
Firstly, in keeping with world-wide trends, there was a large increase in the number of women diagnosed with PAS during the study period – there were almost as many women diagnosed with PAS between 2017-2019 as in the previous 10 years. Furthermore, women managed as part of the MDT were much more likely to have been diagnosed during their pregnancy (on ultrasound and/or MRI) – only 56% of women were diagnosed during pregnancy before MDT care compared to over 90% of women cared for as part of the MDT. This is hugely important as it allows the appropriate plans to be put in place to ensure a safe birth with the right specialists present.
Women with a diagnosis of PAS will need to give birth by caesarean section, and in some cases undergo hysterectomy (removal of the womb) at the same time. As this surgery can be associated with significant complications, mostly related to bleeding and injury to other organs, as part of MDT care a standardised surgical approach is followed for each case with a specialist surgeon performing the operation. Women lost significantly less blood at or around the time of birth compared to those managed before the MDT was established, losing on average 2 litres less. As a result, women were also much less likely to need a blood transfusion as part of MDT care with less than half of women requiring a blood transfusion, and those that required a transfusion needing smaller amounts transfused (average of 1 compared to 4 before MDT care).
Overall, women cared for since the establishment of the MDT service are more likely to be diagnosed during pregnancy, have a planned delivery with less blood loss and are less likely to need a blood transfusion.
Since the publication of this data, the MDT has expanded to include specialists in the Rotunda and Mater hospitals. Currently, a joint MDT is held monthly where teams from the Rotunda and NMH discuss all women with PAS attending both hospitals.
written by Dr Helena Bartels
Click here to read the abstract for this study, or to find links to the full text