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Association of Implementing a Multidisciplinary Team Approach in the Management of Morbidly Adherent Placenta With Maternal Morbidity and Mortality

Bartels, Helena C., MB, MD; Rogers, Ailin C., MB, PhD; O’Brien, Donal, MB, MD; McVey, Ruaidhri, MB, MD; Walsh, Jennifer, MB, PhD; Brennan, Donal J., MB, PhD

doi: 10.1097/AOG.0000000000002865
Obstetric Complications of Pregnancy: Review: PDF Only

OBJECTIVE: To compare maternal outcomes in patients with morbidly adherent placenta managed in a multidisciplinary team setting compared with standard care.

DATA SOURCES: A literature search was performed for publications reporting multidisciplinary pathways in the management of cesarean delivery for patients with morbidly adherent placenta. EMBASE, MEDLINE, PubMed, PubMed Central, ClinicalTrials.gov, and Cochrane databases were searched.

METHODS OF STUDY SELECTION: Databases were searched for studies reporting maternal morbidity of patients with morbidly adherent placenta managed by a multidisciplinary team in a specialist center compared with standard care. Two independent reviewers applied inclusion and exclusion criteria to select included articles, with differences agreed by consensus. A total of 252 citations were reviewed; six studies comprising 461 patients were selected for the analysis.

TABULATION, INTEGRATION, AND RESULTS: Literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results were reported as mean differences or pooled odds ratios (ORs) with 95% CIs. Estimated blood loss was significantly reduced in the multidisciplinary team group (mean difference −1.1 L, 95% CI −1.9 to −0.4, P=.004) and these patients had lower transfusion requirements (mean difference −2.7 units, 95% CI −4.1 to −1.2, P=.040). Those treated in a standard care setting were more likely to develop complications (OR 2.5, 95% CI 1.5–4.0, P<.001); however, there was no difference in length of stay between the two groups.

CONCLUSION: This meta-analysis highlights the improved maternal outcomes in patients with morbidly adherent placenta when managed by a multidisciplinary team in a specialist center. High-risk complex cases warrant expert management in centralized units.

Maternal outcomes are significantly improved in patients with morbidly adherent placenta when managed by a multidisciplinary team in a specialist center.

National Maternity Hospital, Mater Misericordiae University Hospital, and UCD School of Medicine, National Maternity Hospital, Dublin, Ireland.

Corresponding author: Donal J. Brennan, MB, PhD, University College Dublin School of Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland; email: donal.brennan@ucd.ie.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 25, 2018

Received in revised form June 21, 2018

Accepted June 28, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.