Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment?

Nieto-Calvache, Albaro José; Hidalgo, Alejandra; Maya, Juliana; Sánchez, Beatriz; Blanco, Luisa Fernanda; Sinisterra-Díaz, Stiven Ernesto; Benavides-Calvache, Juan Pablo; Padilla, Iván; Aldana, Ivonne; Jaramillo, Martha; Gómez, Ana Maria; Castillo, Angela María Olarte; Bryon, Adriana Messa

doi:10.1055/s-0042-1751060

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev Bras Ginecol Obstet 44 (10) • 2022 • https://doi.org/10.1055/s-0042-1751060 copy

Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment?

Existe um lugar para cesariana centrada na família durante o tratamento do espectro da placenta acreta?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries.

Methods

This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS.

Results

Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case.

Conclusion

Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.

Keywords
placenta accreta; humanization; birthing centers; patient-centered care

Variable	n (%)
Are you familiar with FCDT employed during c-section birth?
● Yes	26 (92.8)
What importance do you give to FCDT during birth?^* * score from 1 to 5, with 1 representing “not important” and 5 representing “very important.”	5 (4–5)^ medium (interquartile range).
Do you apply FCDT during elective c-section?
● Yes	26 (92. 8)
Do you apply FCDT during emerging c-section?
● Yes	14 (50)
What is your preferred type of anesthesia during the management of PAS?
● Neuraxial	27 (96.4)
● General	1 (3.6)
Would you allow the presence of a companion during PAS surgery?
● Yes	7 (25)
Would you allow skin-to-skin contact during PAS surgery?
● Yes	10 (35.7)
What are your reasons for not allowing a companion during the PAS surgery?
• High risk of complications	19 (67.8)
• The presence of a companion hinders the work of health professionals during the management of complications	2 (7.1)
• Caring for the companion can become one more task for an already busy team	3 (10.7)
• During this surgery, information is handled that can be misinterpreted by the companion	1 (3.6)
Would skin-to-skin contact hinder the proper management of the patient affected by PAS?
• Yes	5 (17.8)
If you currently do not allow FCDT, in what situation would you allow them in cases of PAS?
• Under no condition	17 (60.7)
• Only after the severity of the lesion has been determined, and control of the situation has been established	4 (14.3)
• Only if clear criteria are established for FCDT implementation, including time limits for each of the interventions	2 (7.1)
• Personnel in charge of supervising these interventions (skin-to-skin contact and companion in the room) are present	5 (17.9)

Variables	Group 1 (n = 7)	Group 2 (n = 6)
Gestational age (weeks)^* * median (Interquartile Range).	36 (34–38)	34.5 (33–37)
Histological confirmation of PAS. N (%)^ accreta, increta, or percreta.	6 (85.7)	5 (83.3)
Intraoperative blood loss (milliliters)^* * median (Interquartile Range).	1,048 (459–1,480)	1,578 (1,053–2,055)
RBCU transfusion. N (%)	3 (42.8)	2 (33.3)
Hysterectomy. n (%)	4 (57.1)	3 (50)
Uterine tamponade. N (%)	2 (28.5)	3 (50)
Uterine tourniquet. N (%)	5 (71.4)	5 (83.3)
Uterus compression sutures. N (%)	2 (28.5)	3 (50)
Aortic occlusion. n (%)	2 (28.5)	3 (50)
Uterus S2 involvement. N (%)^* ***** involvement of the cervix, parametria, or lower uterine segment.	4 (57.1)	4 (66.6)
Neuraxial anesthesia. N (%)	7 (100)	3 (50)
Duration of surgery (minutes)^* * median (Interquartile Range).	195 (172–220)	178 (135–233)
Neonate weight (grams)^* * median (Interquartile Range).	2,713 (1,846–2,885)	2,564 (2,109–2,968)
APGAR at 10 minutes^* * median (Interquartile Range).	8 (8–8)	9 (8–9)
Hospitalization of the newborn. N (%)	3 (42.8)	3 (50)

Variable	Group 1 (n = 7)	Group 2 (n = 6)
Mother-baby skin contact in the operating room. N (%)	7	0
Companion-baby skin contact in the operating room. N (%)	3	0
Presence of a companion during surgery. N (%)	5	0
Time between birth and mother-newborn contact (hours)^* * median (interquartile range);	0	6.5 (4–36)
Breastfeeding within the first 12 hours of birth. N (%)	3	3
Time between birth and breastfeeding (hours) ^* * median (interquartile range);	8 (2–44)	28 (4–144)
Anesthesiologist report of additional difficulty of anesthetic management due to the implementation of FCDT by the management team. N (%)	0	Does not apply

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[1] Address for correspondence Albaro José Nieto Calvache, MD Fundación Valle Del Lili Cali, Carrera 98# 18-49 Cali 760032 Colombia (e-mail: albaro.nieto@fvl.org.co).