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 |
|---|---|
| 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 |
Keywords
- Placenta accreta spectrum
- management
- haemorrhage
- hysterectomy
- Conservative management