BJOG : an international journal of obstetrics and gynaecology · 2022
Placenta accreta spectrum - variations in clinical practice and maternal morbidity between the UK and France: a population-based comparative study.
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McCall Stephen J, Deneux-Tharaux Catherine, Sentilhes Loïc, Ramakrishnan Rema, Collins Sally L, Seco Aurélien, Kurinczuk Jennifer J, Knight Marian, Kayem Gilles
Аннотация
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.
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.