Placenta accreta spectrum - variations in clinical practice and maternal morbidity between UK and France: a population-based comparative study

Stephen J McCall, Catherine Deneux-Tharaux, Loic Sentilhes, Rema Ramakrishnan, Sally L. Collins, Aurélien Seco, Jennifer J Kurinczuk, Marian Knight, Gilles Kayem* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objective: To compare the management and outcomes of women with Placenta Accreta Spectrum (PAS) in France and the UK.
Design: Two population-based cohorts.
Setting: All obstetrician-led hospitals in the UK and maternity hospitals in eight French regions.
Population: Two-hundred and nineteen women with PAS in France and one-hundred and thirtyfour women in the UK.
Methods: The management and outcomes of women with PAS were compared between the UK and France.
Main outcome measures: Median blood loss, severe postpartum haemorrhage (≥3 litres), postpartum infection and damage to surrounding organs.
Results: The management differed between the two countries; a larger proportion of women with PAS in UK had a caesarean hysterectomy compared to France (43% vs. 26%, P<0.001), while in France, a larger proportion of women with PAS had a uterus conserving approach compared to the UK (36% vs. 19%, <0.001). The 24-hour median blood loss in the UK was 3 litres (IQR:1.7-6.5) compared to 1 litre (IQR:0.5-2.5) in France; more women in the UK had a severe PPH compared to women with PAS in France (58% vs. 21%, P<0.001). There was no difference between the UK and French populations for postpartum infection or organ damage.
Discussion: UK and France have very different approaches to managing PAS, with more women in France receiving a uterine conserving and more women undergoing caesarean hysterectomy in the UK. A life-threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of healthcare systems.
Original languageEnglish
Pages (from-to)1676-1685
Number of pages10
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume129
Issue number10
Early online date29 Apr 2022
DOIs
Publication statusPublished - 9 Aug 2022

Keywords

  • Placenta accreta spectrum
  • management
  • haemorrhage
  • hysterectomy
  • Conservative management

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