Poster Session 2
Category: Operative Obstetrics
Poster Session 2
Tehilla Stamler-Yakobi, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel., Yerushalayim, Israel
Shay Porat, MD, PhD
Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
Yehuda Ginosar, MD
Department of Anesthesiology, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
Shlomo Yahalomy, MD
Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
Doron Kabiri, MD
Hadassah Ein-karem hospital, Obstetrics and gynecology department, Jerusalem
Jerusalem, Yerushalayim, Israel
Jonathan Lober Lorver, MD
Department of Vascular Surgery, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
David Shweiki, MD
Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
Aharon Tevet, MD
Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem
Jerusalem, Yerushalayim, Israel
To compare maternal and fetal outcomes in patients undergoing cesarean delivery (CD) for placenta accreta before and after the introduction of a designated multidisciplinary team incorporating REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta).
Study Design:
A retrospective cohort study of all patients undergoing CD for placenta accreta in a tertiary care center between 2015-2025. We compared outcomes before (group A) and after (group B) the introduction of a multidisciplinary team including obstetrics, pelvic surgery, anesthesia, radiology, and vascular surgery. Data were retrieved from medical records and included maternal and neonatal outcomes. The primary outcomes were the need for hysterectomy and the number of packed red blood cell units transfused. Secondary outcomes included operating time, estimated blood loss, transfusion of fresh frozen plasma, incidence of bladder injury, need for secondary intervention (relaparotomy or interventional angiography), length of ICU stay >24 hours, type of anesthesia used, duration of post-operative hospitalization, and the 5-minute Apgar score.
Results:
Among 81,512 deliveries, 56 patients had placenta accreta: 29 in group A and 27 in group B. Background characteristics-maternal age, gestational age at delivery, parity, and accreta type-were similar, though group B had more prior CDs (2.28 vs. 3.85, p=0.00185). Only one patient in group B required hysterectomy, with concomitant uterine rupture, vs 79.3% in group A (p< .001). Packed cell and FFP transfusions were significantly lower (p< .001), as were blood loss (1590 vs. 2330 mL, p=0.021) and general anesthesia (25.9% vs. 93.1%, p< .001). Fewer patients in group B had ICU stay >24h (11.1% vs. 41.4%, p=0.0047), and no postoperative infections were noted (0% vs. 13.8%, p=0.0425). Apgar at 5 minutes was significantly higher (p=0.0425). No significant differences were observed in rates of bladder injury or post-op stay. Reintervention showed a non-significant trend.
Conclusion:
Implementing a multidisciplinary team with REBOA improved maternal outcomes and nearly obviated the need for hysterectomy.