PASTIME Study Results: Placenta Accreta Outcomes Following Multivessel Uterine Embolization in the OR
BACKGROUND AND PURPOSE:
Melber et al. (AJOG, 2021) assessed a novel multidisciplinary protocol for the treatment of placenta accreta spectrum that included multivessel uterine embolization followed by cesarean hysterectomy
Matched pre-post study
Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization (PASTIME) study protocol
Placenta accrete spectrum cases
Before PASTIME (2010 to 2017): PAS cases managed with internal iliac artery balloon placement in selected cases with inflation at the discretion of surgeon
After PASTIME (2018 to 2021): Cesarean delivery, multivessel uterine embolization, and hysterectomy in a single procedure within a hybrid operative suite (surgical and interventional radiology equipment)
PASTIME cases were compared with historical cases in a 1:2 ratio matched on the basis of PAS severity and surgical urgency
A requirement for transfusion with packed red blood cells
Estimated surgical blood loss
Operative and postoperative complications
Length of stay
Historical cases: 30 | PASTIME cases: 15
PASTIME cases required fewer (median) units of packed red blood cells (P=0.045)
A multidisciplinary protocol for the treatment of placenta accreta spectrum that included a single-surgery protocol with multivessel uterine embolization was associated with reduced need for blood transfusion and lower estimated blood loss
There were no increases in adverse operative outcomes
Lower Apgar score trend in the PASTIME group was attributed to a longer fetal exposure to general anesthesia during femoral line placement
Longer length of neonatal stay may be related to specific fetal or neonatal diagnoses
The authors conclude
The techniques described in the PASTIME protocol warrant consideration by other centers specializing in PAS treatment
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