Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team.
Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team.
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DOI：
10.1016/j.ajog.2019.05.035
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发表时间：
2019-10
影响因子：
9.8
通讯作者：
Shamshirsaz AA
中科院分区：
文献类型：
--
作者：
Erfani H;Fox KA;Clark SL;Rac M;Rocky Hui SK;Rezaei A;Aalipour S;Shamshirsaz AA;Nassr AA;Salmanian B;Stewart KA;Kravitz ES;Eppes C;Coburn M;Espinoza J;Teruya J;Belfort MA;Shamshirsaz AA
在 2015 年母胎医学单位网络研究中，只有一半的植入性胎盘病例在分娩前被怀疑，并且预期病例的结果比意外的植入性胎盘病例要差。这可能是因为产前疑似病例的严重程度较高。我们试图比较美国一家大型中心采用多学科管理方案预期植入性胎盘谱与非预期植入性胎盘谱的结果。这是一项回顾性队列研究，于 2011 年 1 月 1 日至 2018 年 6 月 30 日期间进行，研究对象为学术转诊中心所有经组织学证实的植入性胎盘谱系分娩。分娩时诊断的患者为病例（非预期性植入性胎盘谱），产前诊断的患者为对照（预期性植入性胎盘谱）。主要和次要结果分别是估计失血量和输注的红细胞单位数量。变量以中位数和四分位数范围或数字（百分比）形式报告。使用适当的参数和非参数检验进行分析。 243 名患者中的 54 名 (22.2%) 属于意外植入性胎盘谱组。预期植入性胎盘谱系组的患者既往剖宫产率较高（189 例中的 170 例 [89.9%] 对比 54 例中的 35 例 [64.8%]；P < .001）和前置胎盘率较高（135 例 [74.6%] 对比 19 例 [37.3%]；P < .001）。预期植入胎盘谱中植入/穿透的比例高于意外植入胎盘谱（125 [66.1%] vs 9 [16.7%]，P < .001）。意外植入性胎盘组的两项主要结局均较高（估计失血量，2.4 L [1.4–3] vs 1.7 L [1.2–3]，P = .04；红细胞单位，4 [1–6] vs 2 [0–5]，P = .03）。我们的数据与母胎医学单位的结果相矛盾，相反，尽管有很高比例的女性患有更严重的胎盘侵犯，但预期植入性胎盘谱组的结果却更好。我们将此归因于我们在预期病例管理方面的多学科方法和持续的流程改进。经验丰富的团队的存在似乎是侵入性胎盘谱中孕产妇发病率比胎盘浸润深度更重要的决定因素。
In a 2015 Maternal-Fetal Medicine Units Network study, only half of placenta accreta spectrum cases were suspected before delivery, and the outcomes in the anticipated cases were paradoxically poorer than in unanticipated placenta accreta spectrum cases. This was possibly because the antenatally suspected cases were of greater severity. We sought to compare the outcomes of expected vs unexpected placenta accreta spectrum in a single large US center with multidisciplinary management protocol. This was a retrospective cohort study carried out between Jan. 1, 2011, and June 30, 2018, of all histology-proven placenta accreta spectrum deliveries in an academic referral center. Patients diagnosed at the time of delivery were cases (unexpected placenta accreta spectrum), and those who were antentally diagnosed were controls (expected placenta accreta spectrume). The primary and secondary outcomes were the estimated blood loss and the number of red blood cell units transfused, respectively. Variables are reported as median and interquartile range or number (percentage). Analyses were made using appropriate parametric and nonparametric tests. Fifty-four of the 243 patients (22.2%) were in the unexpected placenta accreta spectrum group. Patients in the expected placenta accreta spectrum group had a higher rate of previous cesarean delivery (170 of 189 [89.9%] vs 35 of 54 [64.8%]; P < .001) and placenta previa (135 [74.6%] vs 19 [37.3%]; P < .001). There was a higher proportion of increta/percreta in expected placenta accreta spectrum vs unexpected placenta accreta spectrum (125 [66.1%] vs 9 [16.7%], P < .001). Both primary outcomes were higher in the unexpected placenta accreta spectrum group (estimated blood loss, 2.4 L [1.4–3] vs 1.7 L [1.2–3], P = .04; red blood cell units, 4 [1–6] vs 2 [0–5], P = .03). Our data contradict the Maternal-Fetal Medicine Units results and instead show better outcomes in the expected placenta accreta spectrum group, despite a high proportion of women with more severe placental invasion. We attribute this to our multidisciplinary approach and ongoing process improvement in the management of expected cases. The presence of an experienced team appears to be a more important determinant of maternal morbidity in placenta accreta spectrum than the depth of placental invasion.
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影响因子：
1.5
作者：
Shamshirsaz, Alireza A.;Fox, Karin A.;Belfort, Michael A.
通讯作者：
Belfort, Michael A.
影响因子：
7.2
作者：
Bailit, Jennifer L.;Grobman, William A.;Blackwell, Sean C.
通讯作者：
Blackwell, Sean C.
影响因子：
7.2
作者：
Shamshirsaz, Alireza A.;Fox, Karin A.;Belfort, Michael A.
通讯作者：
Belfort, Michael A.
DOI：
10.1111/1471-0528.13547
发表时间：
2016-07-01
影响因子：
5.8
作者：
Thurn, L.;Lindqvist, P. G.;Kallen, K.
通讯作者：
Kallen, K.
DOI：
10.1111/1471-0528.12405
发表时间：
2014-01
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Fitzpatrick KE;Sellers S;Spark P;Kurinczuk JJ;Brocklehurst P;Knight M
通讯作者：
Knight M