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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(08): 1008-1018
DOI: 10.1055/s-0042-1749664
Original Article

Implementation and Outcomes of a Model of Care for Placenta Accreta Spectrum in a Community-Based Private Practice

William Wagner
1   Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
,
Matthew Loichinger
1   Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
,
Abbey C. Sidebottom
2   Care Delivery Research, Allina Health, Minneapolis, Minnesota
,
Whitney L. Wunderlich
2   Care Delivery Research, Allina Health, Minneapolis, Minnesota
,
Marc Vacquier
2   Care Delivery Research, Allina Health, Minneapolis, Minnesota
,
Theresa Jentink
1   Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
,
Marijo N. Aguilera
3   Health Partners Maternal Fetal Medicine, St. Paul, Minnesota
,
Sureshbabu N. Ahanya
1   Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
,
Elizabeth Morgan
4   Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
,
Meiling Parker
3   Health Partners Maternal Fetal Medicine, St. Paul, Minnesota
,
Donald D. Wothe
3   Health Partners Maternal Fetal Medicine, St. Paul, Minnesota
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Abstract

Objective The aim of the study is to describe a model of care and outcomes for placenta accreta spectrum (PAS) implemented in the context of a community based non-academic health system.

Study Design The program for management of PAS includes a multidisciplinary team approach with protocols for ultrasound assessment, diagnosis, and surgery. The program was implemented in the two largest private hospitals in the Twin Cities, Minnesota, United States. Maternal and fetal outcomes as well as cost were compared for histopathologic confirmed PAS cases before (2007–2014, n = 41) and after (2015–2017, n = 26) implementation of the PAS program.

Results Implementation of the PAS program was associated with ICU admission reductions from 53.7 to 19.2%, p = 0.005; a decrease of 1,682 mL in mean estimated blood loss (EBL) (p = 0.061); a decrease in transfusion from 85.4 to 53.9% (p = 0.005). The PAS program also resulted in a (non-significant) decrease in both surgical complications from 48.8 to 38.5% (p = 0.408) and postoperative complications from 61.0 to 42.3% (p = 0.135). The total cost of care for PAS cases in the 3 years after implementation of the program decreased by 33%.

Conclusion The implementation of a model of care for PAS led by a perinatology practice at a large regional non-academic referral center resulted in reductions of ICU admissions, operating time, transfusion, selected surgical complications, overall postoperative complications, and cost.

Key Points

  • Implementation of a PAS care model resulted in reduced ICU admissions from 53.7% to 19.2%.

  • Patient safety increased by reducing blood loss, transfusions and postoperative complications.

  • This model decreased operating time, as well as total cost of care by 33%.

Keywords

accreta - increta - percreta - placenta accreta spectrum

Conflict of Interest

None declared.




Publication History

Received: 16 March 2021

Accepted: 17 February 2022

Article published online:
10 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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