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Sunday, June 28, 2009
Hall A (San Diego Convention Center)
Placenta accreta is a severe obstetric complication involving an abnormal attachment of the placenta to the myometrium. The placenta usually detaches from the uterine wall easily, but women with a placenta accreta are at great risk of hemorrhage during its removal and commonly require surgery to stop the bleeding, often leading to a hysterectomy. Placenta accreta affects approximately 1 in 2,500 pregnancies; risk factors include prior cesarean section delivery. As the national C-Section rate continues to increase, so does the incidence of placenta accreta. Over the last 10 years, we have seen our cesarean delivery rate steadily increase; the number of patients with abnormal placental implantation has, also, risen. In the early 1990’s a team of physicians, nurses, social workers, pharmacists gathered to plan the admission of a young mother of 2 other children with a diagnosis of placenta accreta; we knew that she had a great risk of bleeding excessively during delivery. With more experiences, expert surgical skills and a collaborative/proactive approach, what was once a dreaded admission is now considered routine at our facility. Today, when a patient is identified, the primary physician notifies the Clinical Nurse Specialist who is responsible for coordinating the the care conference. Included at the table is the OB Resident and Perinatal Fellow who present the case; the Anesthesiologist, Perinatalolgist, Gyn-Oncologist, Neonatologist, Interventional Radiology, SICU staff/CNS, L&D staff/manager, NICU staff/Educator, OR staff/manager, Social Services, and Case Manager provide input. The plan of care includes dates/times of elective admission, transfer to L&D, IR, and OR and surgery “start”. Also, an emergency delivery plan is confirmed just in case the patient experiences vaginal bleeding and requires emergency delivery. The patient and family are also included in the preparations for their experience in our facility. With advances in Ultrasound examination, MRI, Interventional Radiology, collaboration with various specialists, and the inclusion of a multidisciplinary patient care conference prior to delivery, we have found that our outcomes for patients diagnosed with a placenta accreta are good for both mom and baby.
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