Multicountry Outcomes in Grade 3 Placenta Accreta

TOPLINE:

Severe postpartum haemorrhage (PPH) in grade 3 placenta accreta spectrum (PAS) varied significantly by country, with Italy showing the best outcomes due to standardised hysterectomy protocols.

METHODOLOGY:

• This multicountry study compared the clinical management and outcomes of grade 3 PAS in three studies conducted across the United Kingdom (2010-2011), France (2013-2015), and Italy (2014-2016).
• Researchers conducted a prospective analysis of data from national registries and included 124 women with confirmed grade 3 PAS (United Kingdom, 39 women; France, 51 women; and Italy, 34 women), representing 30%-49% of national births in each country during study periods.
• They evaluated prior uterine surgery rates (15% in the United Kingdom, 32% in France, and 50% in Italy) and prenatal detection rates (59% in the United Kingdom, 88% in France, and 82% in Italy) and analysed treatment approaches (conservative management vs caesarean hysterectomy).
• Primary outcomes included PPH (estimated total blood loss ≥ 3000 mL) and transfusion (four or more units of red blood cells); surgical results (hysterectomy rates), maternal complications (visceral injury and infections), and intensive care unit admissions were also analysed.

TAKEAWAY:

• Hysterectomy rates were 62% in the United Kingdom, 39% in France, and 100% in Italy (P < .01 for the global test).
• With universal hysterectomy, Italy had lowest PPH (12% vs 54% in the United Kingdom vs 25% in France; P < .01 for the global test) and transfusion rates (41% vs 67% in the United Kingdom vs 47% in France; P = .06).
• Uterine preservation was attempted only in the United Kingdom (51%) and France (59%). Hysterectomy rates reached 69% in the United Kingdom and 59% in France.
• Bowel damage rates were consistent (approximately 18%-19% across all countries; P = .95 for the global test); infections spiked in France (30% vs 0% elsewhere; P < .01 for the global test).
• Italy with higher prenatal detection avoided placental removal attempts (18% vs 49% in the United Kingdom vs 16% in France; P < .01 for the global test).

IN PRACTICE:

“Maternal outcomes in women with grade 3 PAS varied between the three periods and countries, alongside the evolution in prenatal screening, peri-operative management and organisation of care for these women,” the authors wrote.

SOURCE:

This study was led by Anne Pinton, Université Paris Cité, INSERM, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France. It was published online on April 07, 2025, in BMC Pregnancy and Childbirth.

LIMITATIONS:

Potential overdiagnosis of grade 3 PAS in women who received only conservative treatment (lacking histopathologic analysis), heterogeneity in outcome data collection methods, and the small sample size were some of the limitations, restricting generalisability across differing national practice patterns.

DISCLOSURES:

This research was funded by the National Institute for Health and Care Research for the United Kingdom, the French Health Ministry and Angers University Hospital for France, and the Italian Ministry of Health for Italy. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.