Multidisciplinary protocol and outcomes in placenta accreta spectrum: a 12 year cohort study

BACKGROUND: Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes. OBJECTIVE: To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes. STUDY DESIGN: This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery. RESULTS: After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260 mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9 days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022. CONCLUSION: Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.