Impact of Targeted Scanning Protocols on Perinatal Outcomes in Pregnancies at Risk of Placenta Accreta Spectrum or Vasa Previa.

Impact of Targeted Scanning Protocols on Perinatal Outcomes in Pregnancies at Risk of Placenta Accreta Spectrum or Vasa Previa.

Am J Obstet Gynecol. 2018 Jan 15;:

Authors: Melcer Y, Jauniaux E, Maymon S, Tsviban A, Pekar-Zlotin M, Betser M, Maymon R

Abstract
BACKGROUND: Placenta accreta spectrum (PAS) and vasa previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes.
OBJECTIVES: To compare perinatal outcome in women with PAS or VP before and after implementation of targeted scanning protocols.
METHODS: This retrospective study included two non-concurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 versus 2013-2016 for PAS and 1988-2007 versus 2008-2016 for VP). Clinical reports of women diagnosed with PAS and VP during the study periods were reviewed and outcomes were compared.
RESULTS: In total, there were 97 cases of PAS and 51 cases with VP, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the s scanning protocols (28/65 (43.1%) cases versus 31/32 (96.9%) cases; p<0.001 for PAS and 9/18 (50%) cases versus 29/33 (87.9%) cases, 87.9%; p<0.01 for VP). The perinatal outcome improved also significantly in both cohorts after implementation of the protocols. In PAS cohort, the estimated blood loss and the postoperative hospitalization stay decreased between periods (1520±845 versus 1168±707 ml, p<0.01 and 10.9 ± 14.1 versus 5.7± 2.2 days, p<0.05, respectively). In VP cohort, the number of 5 minute Apgar score ≤5 and umbilical cord pH<7 decreased between periods (5/18 (27.8%) cases versus 1/33 (3%) cases; p<0.05) and 4/18 (22.2%) cases versus 1/33 (3%) cases; p<0.05, respectively).
CONCLUSIONS: The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for PAS and VP was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and used of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.

PMID: 29353034 [PubMed - as supplied by publisher]

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