A Multidisciplinary Approach for Reducing Complications During Cesarean Sections for Placenta Accreta

BACKGROUND Placenta accreta spectrum (PAS) is a serious obstetric condition marked by abnormal placental adherence to the uterine wall, often leading to significant maternal and fetal complications. Women with a history of cesarean section (CS) are at increased risk. The standard treatment is CS, which carries high complication rates, including hemorrhage, urological injury, and the potential need for hysterectomy. Traditionally, these surgeries are performed solely by obstetricians. OBJECTIVES To evaluate whether a multidisciplinary team (MDT) approach improves surgical outcomes and reduces complications in women with PAS. STUDY DESIGN We retrospectively reviewed medical records of 417 women diagnosed with PAS between 2011 and 2022. In 2019, our institution adopted an MDT protocol that includes preoperative obstetric and urological evaluation, joint surgical planning, and the intraoperative insertion of bilateral ureteral catheters (UCs). Outcomes were compared between patients treated before and after MDT implementation. RESULTS Of 417 women, 108 (25.9%) were managed using the MDT protocol. Estimated blood loss was significantly lower in the MDT group (1297cc vs. 1586cc, P = .036), with fewer requiring transfusions (2.8% vs. 8.4%, P = .002). Hysterectomy rates were also reduced (0.9% vs. 7.4%, P = .04). Urological injury occurred in only 4.7% of MDT cases versus 13.9% in the non-MDT group (P = .027). The overall complication rate was significantly lower in the MDT group (5.6% vs. 15.6%, P = .007). CONCLUSION An MDT approach significantly reduces surgical complications in PAS, supporting its implementation as standard care.