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Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study

  • Clinical Investigation
  • Arterial Interventions
  • Published:
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Abstract

Introduction

Hysterectomy is the standard of care in placenta accreta spectrum (PAS). To reduce the risks of obstetric hemorrhage during surgery, endovascular interventions have been proposed. Our aim is to evaluate the feasibility and safety of the overall non-conservative management of PAS in the hybrid operating room (OR) to replace the classic two-step procedure (catheterization in the interventional radiology suite and transfer to conventional OR).

Materials and Methods

This is a retrospective study of series of patients with histopathologic confirmation of PAS treated in the hybrid OR at the same university hospital. We used for comparison our historical cohort managed with the standard two-step procedure.

Results

We included 110 patients, 80 in the conventional OR and 30 in the hybrid OR. There were no cases of major complications attributable to the endovascular procedures. In the two-step procedure, there were 10 (12.5%) intra-arterial catheter displacements that required repositioning in the conventional OR under mobile C-arm fluoroscopy and no cases in the hybrid OR (p = 0.04). The mean operative time was 380 + 42 min in the conventional OR and 296 + 66 min in the hybrid OR (p = .00001). There were no differences in the gestational age at delivery, postoperative length of stay, or large-volume blood transfusion. There were no maternal deaths.

Conclusions

The overall non-conservative management of PAS in the hybrid OR has shown to be feasible and safe in our series, offering potential advantages to replace the classic two-step procedure. More studies are needed to evaluate whether this strategy is cost-effective and whether it may improve maternal and perinatal outcomes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    César Hernán Meller, Gustavo Izbizky, Marina Lamm & Lucas Otaño

  2. Department of Radiology, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina

    Ricardo D. Garcia-Monaco & Oscar Peralta

  3. Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Jorge Jaunarena

Authors
  1. César Hernán Meller
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  2. Ricardo D. Garcia-Monaco
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  3. Gustavo Izbizky
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  4. Marina Lamm
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  5. Jorge Jaunarena
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  6. Oscar Peralta
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  7. Lucas Otaño
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Correspondence to Ricardo D. Garcia-Monaco.

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Meller, C.H., Garcia-Monaco, R.D., Izbizky, G. et al. Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study. Cardiovasc Intervent Radiol 42, 365–370 (2019). https://doi.org/10.1007/s00270-018-2113-y

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  • DOI: https://doi.org/10.1007/s00270-018-2113-y

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