Obstetric and haematological management and outcomes of women with placenta accreta spectrum by planned or urgent delivery: Secondary data analysis of a public referral hospital in Lebanon

Stephen J McCall; Sara Mansour; Janoub Khazaal; Gilles Kayem; Jocelyn DeJong; Rabih Chahine

doi:10.1371/journal.pone.0302366

Obstetric and haematological management and outcomes of women with placenta accreta spectrum by planned or urgent delivery: Secondary data analysis of a public referral hospital in Lebanon

PLoS One. 2024 May 8;19(5):e0302366. doi: 10.1371/journal.pone.0302366. eCollection 2024.

Authors

Stephen J McCall¹, Sara Mansour¹, Janoub Khazaal², Gilles Kayem^{1

3

4}, Jocelyn DeJong⁵, Rabih Chahine²

Affiliations

¹ Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon.
² Department of Obstetrics and Gynecology, Rafik Hariri University Hospital, Beirut, Lebanon.
³ Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France.
⁴ Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon.

Abstract

Background: Lebanon has a high caesarean section use and consequently, placenta accreta spectrum (PAS) is becoming more common.

Objectives: To compare maternal characteristics, management, and outcomes of women with PAS by planned or urgent delivery at a major public referral hospital in Lebanon.

Design: Secondary data analysis of prospectively collected data.

Setting: Rafik Hariri University Hospital (public referral hospital), Beirut, Lebanon.

Participants: 159 pregnant and postpartum women with confirmed PAS between 2007-2020.

Main outcome measures: Maternal characteristics, management, and maternal and neonatal outcomes.

Results: Out of the 159 women with PAS included, 107 (67.3%) underwent planned caesarean delivery and 52 (32.7%) had urgent delivery. Women who underwent urgent delivery for PAS management were more likely to experience antenatal vaginal bleeding compared to those in the planned group (55.8% vs 28.0%, p<0.001). Median gestational age at delivery was significantly lower for the urgent group compared to the planned (34 vs. 36 weeks, p<0.001). There were no significant differences in terms of blood transfusion rates and major maternal morbidity between the two groups; however, median estimated blood loss was significantly higher for women with urgent delivery (1500ml vs. 1200ml, p = 0.011). Furthermore, the urgent delivery group had a significantly lower birth weight (2177.5g vs. 2560g, p<0.001) with higher rates of neonatal intensive care unit (NICU) admission (53.7% vs 23.8%, p<0.001) and perinatal mortality (18.5% vs 3.8%, p = 0.005).

Conclusion: Urgent delivery among women with PAS is associated with worse maternal and neonatal outcomes compared to the planned approach. Therefore, early referral of women with known or suspected PAS to specialized centres is highly desirable to maximise optimal outcomes for both women and infants.

Copyright: © 2024 McCall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adult
Blood Transfusion / statistics & numerical data
Cesarean Section* / statistics & numerical data
Delivery, Obstetric / statistics & numerical data
Female
Hospitals, Public / statistics & numerical data
Humans
Infant, Newborn
Lebanon / epidemiology
Placenta Accreta* / epidemiology
Placenta Accreta* / therapy
Pregnancy
Pregnancy Outcome / epidemiology
Referral and Consultation
Secondary Data Analysis

Grants and funding

This study was funded by the University Research Board (Grant number: 104112) at the American University of Beirut (AUB) awarded to JD and SM. The funder had no participation in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.