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Recording available 2/16-5/2
Recording available 2/16-5/2
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Oral Concurrent Session 9 - Quality

Oral Concurrent Sessions

Oral Concurrent Session 9 - Quality

(93) Higher Hospital Volume Is Associated with Reduced Maternal Morbidity in Placenta Accreta Spectrum

Friday, February 13, 2026
8:45 AM - 9:00 AM  
Location: Summit 218 - 221

    Submitting Author and Presenting Author(s)

  • May Abiad, MD (she/her/hers)

    Resident Physician
    Baptist Memorial Medical Education
    Memphis, Tennessee, United States

    • Coauthor(s)

  • Scott A. Shainker, DO, MS (he/him/his)

    Director, New England Center for Placental Disorders / Associate Professor of Obstetrics, Gynecology, and Reproductive Biology
    Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School
    Boston, Massachusetts, United States

  • Karin A. Fox, MD, MEd

    Professor
    Division of Maternal Fetal Medicine, The University of Texas Medical Branch Health
    Galveston, Texas, United States

  • Anna M. Modest, MPH, PhD

    Faculty Scientist
    Beth Israel Deaconess Medical Center
    Boston, Massachusetts, United States

  • Giulia Bonanni, MD

    Postdoctoral Research Fellow
    Boston Children's Hospital
    Boston, Massachusetts, United States

  • GS

    George R. Saade, MD

    Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • Hiba J. Mustafa, MD (she/her/hers)

    Director of Fetal Surgery, Director of Placenta Accreta Spectrum Program
    Indiana University School of Medicine, Riley Children's Hospital
    Indianapolis, Indiana, United States

  • LA

    Lamia K. Atasi, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mercy Hospital
    St. Louis, Missouri, United States

  • AN

    Albaro Nieto-Calvache, MD

    Departamento de Ginecología y Obstetricia, Unidad de Alta Complejidad Obstétrica, Fundación Clínica Valle del Lili
    Cali, Valle del Cauca, Colombia

  • Rachel K. Harrison, MD (she/her/hers)

    Clinical Professor Maternal-Fetal Medicine
    Department of Maternal-Fetal Medicine, Advocate Aurora Health
    Chicago, Illinois, United States

  • JN

    J. M. Newton, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center,
    Nashville, Tennessee, United States

  • Andrea L. Greiner, MD, MHA

    Clinical Professor
    Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics
    Iowa City, Iowa, United States

  • Sonya S. Abdel-Razeq, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University
    New Haven, Connecticut, United States

  • Daniela A. Carusi, MD, MSc (she/her/hers)

    Associate Professor
    Department of Obstetrics and Gynecology, MassGeneral Brigham; Division of Maternal-Fetal Medicine; Harvard Medical School
    Boston, Massachusetts, United States

  • AC

    Alissa R. Carver, MD

    Department of Obstetrics and Gynecology, Wilmington Maternal-Fetal Medicine
    Wilmington, North Carolina, United States

  • Christina M. Duzyj, MD, MPH (she/her/hers)

    Director, Maternal Fetal Medicine Fellowship Program
    Department of Obstetrics and Gynecology, MassGeneral Brigham; Division of Maternal-Fetal Medicine; Harvard Medical School
    Boston, Massachusetts, United States

  • Brett D. Einerson, MD, MPH (he/him/his)

    Associate Professor, Director of The Utah Placenta Accreta Program
    Department of Obstetrics and Gynecology, University of Utah Health
    Salt Lake City, Utah, United States

  • CA

    Clarel Antoine, MD

    Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
    New York, New York, United States

  • JK

    Julie Kang, DO

    Department of Maternal-Fetal Medicine, Memorial Healthcare System
    Tampa, Florida, United States

  • DL

    Deirdre J. Lyell, MD

    Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford School of Medicine
    Stanford, California, United States

  • AS

    Amir A. Shamshirsaz, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine
    Houston, Texas, United States

  • Alfred Abuhamad, MD (he/him/his)

    Executive Vice President, Virginia Health Sciences at Old Dominion University
    Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • Baha M. Sibai, MD

    Professor
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • RS

    Robert M. Silver, MD

    Department of Obstetrics and Gynecology, University of Utah Health
    Salt Lake City, Utah, United States

  • Alireza A. Shamshirsaz, MD (he/him/his)

    Boston Children’s Hospital, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School
    Boston, Massachusetts, United States

Objective:
To evaluate the relationship between hospital volume and maternal outcomes in patients with PAS and placenta previa, focusing on morbidity across low-, medium-, and high-PAS-volume centers.

Study Design:
This retrospective observational study utilized the Nationwide Readmissions Database (2017–2019) to identify delivery hospitalizations with diagnoses of PAS and placenta previa using ICD-10 codes. Hospitals were stratified into low- (≤3 PAS cases/year), medium- (4–12 cases/year), and high-volume (≥13 cases/year) groups based on annual PAS case volume quartiles. The primary outcome was hemorrhage. Secondary outcomes included maternal transfusion, disseminated intravascular coagulation (DIC), shock, urinary system repair, and length of stay. A composite maternal morbidity score included hemorrhage, DIC, shock, blood transfusion, ventilation, and urinary system repair. Univariable and multivariable logistic regression models were used to assess the impact of hospital volume on maternal outcomes, adjusting for patient and hospital characteristics.

Results:
Among 2,165 patients with PAS and placenta previa, those managed at high volume hospitals experienced significantly lower rates of hemorrhage (57.2% vs. 67.4%, p = 0.002) and composite maternal morbidity without transfusion (63.0% vs. 70.3%, p = 0.036) compared to low volume hospitals. Blood transfusion rates were also lower at high volume hospitals (30.6% vs. 37.7%, p = 0.044). Multivariable analysis demonstrated that delivery at high volume hospitals was associated with reduced odds of hemorrhage (aOR 0.62, 95% CI 0.46–0.84) and transfusion (aOR 0.61, 95% CI 0.44–0.84) compared to low volume hospitals. Patients delivering at high volume hospitals also had significantly fewer severe complications, including DIC and shock. Length of stay from delivery to discharge remained consistent across groups.

Conclusion:
High PAS-volume hospitals demonstrated better maternal outcomes in patients with PAS and placenta previa, highlighting the benefits of multidisciplinary care with experienced teams in managing these high-risk cases.