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.
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 language | English |
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Pages (from-to) | 1676-1685 |
Number of pages | 10 |
Journal | BJOG-An International Journal of Obstetrics and Gynaecology |
Volume | 129 |
Issue number | 10 |
Early online date | 29 Apr 2022 |
DOIs | |
Publication status | Published - 9 Aug 2022 |
Bibliographical note
SM's DPhil was funded by the UK’s Medical Research Council (UK). PACCRETA was funded by the French Health Ministry under its Clinical Research Hospital Program (grant no. AOR12156) and by the Angers University Hospital. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the article.Data Availability Statement
Request for access to the data should be directed to the steering committee of the relevant country. Requests for access to the French data (PACCRETA) should be directed to epope@inserm.fr. Requests for access to the UK dataset will be considered by the National Perinatal Epidemiology Unit Data Sharing committee. Access to the UK data can be requested from general@npeu.ox.ac.ukAdditional supporting information may be found in the online version of the article at the publisher’s website.
Keywords
- placenta accreta spectrum
- management
- haemorrhage
- hysterectomy
- conservative management