Placenta accreta spectrum - variations in clinical practice and maternal morbidity between the UK and France: a population-based comparative study

Stephen J McCall; Catherine Deneux-Tharaux; Loïc Sentilhes; Rema Ramakrishnan; Sally L Collins; Aurélien Seco; Jennifer J Kurinczuk; Marian Knight; Gilles Kayem

doi:10.1111/1471-0528.17169

Placenta accreta spectrum - variations in clinical practice and maternal morbidity between the UK and France: a population-based comparative study

BJOG. 2022 Sep;129(10):1676-1685. doi: 10.1111/1471-0528.17169. Epub 2022 Apr 29.

Authors

Stephen J McCall^{1

2

3}, Catherine Deneux-Tharaux², Loïc Sentilhes⁴, Rema Ramakrishnan¹, Sally L Collins^{5

6}, Aurélien Seco⁷, Jennifer J Kurinczuk¹, Marian Knight¹, Gilles Kayem^{2

8}

Affiliations

¹ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
² Université de Paris, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France.
³ Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
⁴ Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
⁵ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁶ Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.
⁷ Clinical Research Unit, Paris-Descartes Necker/Cochin, Paris, France.
⁸ Hôpital Trousseau, Assistance Publique -Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.

Abstract

Objective: To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK.

Design: Two population-based cohorts.

Setting: All obstetrician-led hospitals in the UK and maternity hospitals in eight French regions.

Population: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK.

Methods: The management and outcomes of women with PAS were compared between the UK and France.

Main outcome measures: Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs.

Results: The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus-preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7-6.5 l), compared with 1 l (IQR 0.5-2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: '24 hour' has been changed to 'total' in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage.

Conclusions: The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine-conserving approach and more women in the UK undergoing caesarean hysterectomy. A life-threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France.

Tweetable abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France.

Keywords: conservative management; haemorrhage; hysterectomy; management; placenta accreta spectrum.

MeSH terms

Cesarean Section
Female
Humans
Hysterectomy
Placenta Accreta* / epidemiology
Placenta Accreta* / surgery
Postpartum Hemorrhage* / epidemiology
Postpartum Hemorrhage* / surgery
Pregnancy
Retrospective Studies
United Kingdom / epidemiology

Abstract

MeSH terms

Grants and funding