Invasive placental disease: the impact of a multi-disciplinary team approach to management

Purpose: To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD). Materials and methods: This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started. Results: There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260min versus 181min, p=0.0001), less blood loss (1200mL versus 2500mL, p=0.009), less administration of blood products (47.4% versus 85.7%, p=0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57mmHg versus 48mmHg, p=0.002, when compared to the No-MDT (n=28) approach. No differences were found for other outcomes. Conclusion: Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.