Are women antenatally diagnosed with abnormally invasive placenta receiving optimal management in England? An observational study of planned place of delivery

Abstract

Introduction: The aim of this study was to investigate the planned place of delivery for women antenatally diagnosed with abnormally invasive placenta (AIP) in England and identify how many units regard themselves to be "specialist centers" for the management of AIP.

Material and methods: Observational study of obstetric-led units in England. An anonymous survey was sent to the delivery suite lead clinician in all 154 consultant-led units throughout England. The main outcome measures were whether each unit planned to manage AIP "in-house", the estimated number of AIP cases delivered in the previous 5 years and whether the unit considered itself a "specialist center" for AIP management.

Results: In all, 114 of 154 units responded (74%): 80 (70%) manage AIP cases "in-house", 23 (29%) of these report that they regard themselves "specialist centers" for AIP. The 23 "specialist centers" managed significantly more cases than "non-specialist centers" (5.4, 95% confidence interval (CI) 4.3-7.3 vs 2.3, 95% CI 1.5-3.1 cases/unit/year; P < .001); nearly one-third of "non-specialist centers" manage less than 1 case per year. Extrapolating the reported number of cases to all 154 obstetrician-led delivery units produces an estimate of 5.2 cases per 10 000 births over the last 5 years.

Conclusions: Most units plan to manage AIP "in-house" despite encountering few cases each year. Centralizing care would allow the multidisciplinary team in each "specialist center" to develop significant experience in the management of this rare condition, leading to improved outcomes for the women.

Keywords: abnormally invasive placenta; obstetrics; placenta accreta.

Conflict of interest statement

Conflict of Interest notification

The authors have no conflicts of interest to declare

© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

Figures

Figure 1

Flow diagram showing the exact breakdown of responses. Of the 80 units that manage cases ‘in-house’, 23 (29%) regard themselves ‘specialist centres’ for the abnormally-invasive placenta (AIP) delivery, 57 (71%) units planned to manage AIP cases themselves but did not regard themselves a ‘specialist centre’. The 40 ‘non-specialists’ that managed cases themselves and provided full data managed significantly fewer cases than the units that regarded themselves as ‘specialists’ (4 vs 1.5 cases/unit/year, p