• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

PASTIME Study Results: Placenta Accreta Outcomes Following Multivessel Uterine Embolization in the OR

image_pdfFavoriteLoadingFavorite

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

METHODS:

  • Matched pre-post study
    • Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization (PASTIME) study protocol 
  • Participants
    • Placenta accrete spectrum cases
  • Exposures
    • 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)
  • Study design
    • PASTIME cases were compared with historical cases in a 1:2 ratio matched on the basis of PAS severity and surgical urgency
  • Primary outcome
    • A requirement for transfusion with packed red blood cells
  • Secondary outcome
    • Estimated surgical blood loss
    • Operative and postoperative complications
    • Procedural time
    • Length of stay
    • Neonatal outcomes

RESULTS:

  • Historical cases: 30 | PASTIME cases: 15
  • PASTIME cases required fewer (median) units of packed red blood cells (P=0.045)
    • Historical cases: 2 (IQR 0 to 4.5) units
    • PASTIME cases: 0 (IQR 0 to 2) units
  • No differences in requirement of any blood transfusions between the groups (P=0.11)
    • Historical cases: 63.3%
    • PASTIME cases: 33.3%
  • Estimated blood loss (median) was significantly less in PASTIME group (P=0.003)
    • Historical: 1750 (IQR 1050 to 2500) mL
    • PASTIME: 750 (IQR 450 to 1050) mL
  • There was no significant difference in the number of cases requiring massive transfusion (≥10 red blood cell units in 24 hours) (P=0.15)
    • Historical: 16.7%
    • PASTIME: 0%
  • Intraoperative deaths from hemorrhagic shock
    • Historical: 2 cases
    • PASTIME: 0 cases
  • Mean duration of the interventional radiology procedure was longer in the PASTIME (P=0.002)
    • Historical: 34.1 minutes
    • PASTIME: 67.8 minutes
  • The following were not significantly different between groups
    • ICU admission
    • Postpartum length of stay
    • Surgical and postoperative complications
    • Gestational age
    • Neonatal birthweights
  • The neonatal length of stay was longer in the PASTIME group (P=0.02)
    • Historical: median duration 15 days
    • PASTIME: 32 days
  • There was a trend towards low 5-minute Apgar score (<7) in the PASTIME group (P=0.06)
    • Historical: 38.5%
    • PASTIME: 76.9%
  • There were no significant differences in the
    • Incidence of arterial umbilical cord blood pH <7.2
    • Incidence of respiratory distress syndrome
    • Intubation rates

CONCLUSION:

  • 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

Learn More – Primary Sources:

Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization: the PASTIME protocol

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Does MRI Help or Hurt When Making a Diagnosis of Placenta Accreta?
Delayed Hysterectomy for Placenta Percreta: Does it Reduce Need for Transfusions?
Does Labor Before Cesarean Section Decrease Risk of Accreta in Later Pregnancies?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site