(125) Optimal timing of delivery of placenta accreta with previa: A Decision Analysis.

Placenta accreta spectrum (PAS) with placenta previa poses a significant risk of maternal morbidity and mortality. While scheduled delivery between 34 and 36 weeks is standard, the optimal gestational age for delivery remains uncertain. This study aimed to evaluate maternal and neonatal outcomes associated with different planned delivery timings for individuals with PAS and previa.

Study Design:

A decision-analytic model was constructed using TreeAge software to compare planned delivery at 33+0, 34+0, 35+0, 36+0, and 37+0 weeks gestation in those with PAS and placenta previa. The theoretical cohort included 2,565 individuals, the approximate number of pregnant individuals affected by PAS and placenta previa in the U.S. Maternal outcomes included maternal death, ICU admission, and uncomplicated delivery resulting in healthy infants, while neonatal outcomes included neonatal death and neurodevelopmental delay. Probabilities, utilities, and costs were derived from literature. QALYs were discounted at a rate of 3%.

Results:

Delivery at 36 weeks resulted in the highest number of healthy infants. When compared to delivery at 33 weeks, scheduled delivery at 36 weeks prevented 35 neonatal deaths and 22 cases of neurodevelopmental delay. Rates of maternal death and maternal ICU admission were comparable across gestational age of delivery. Overall, planned delivery at 36 weeks yielded the greatest benefit, resulting in 144,026 additional QALYS — the highest among all gestational ages evaluated. Compared specifically to planned delivery at 34 and 35 weeks, delivery at 36 weeks was associated with 875 and 289 more QALYs, respectively. An example of the condensed decision tree can be found in Figure 1.

Conclusion:

Optimal timing of delivery for PAS with previa involves balancing maternal risks with neonatal complications. This decision analysis suggests that delivery at 36 weeks may minimize maternal and neonatal overall morbidity. Additional studies are needed to validate these findings and inform individualized delivery planning.