Placenta accreta spectrum - variations in clinical practice and maternal morbidity between the UK and France: a population-based comparative study.

Abstract

To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK. Two population-based cohorts. All obstetrician-led hospitals in the UK and maternity hospitals in eight French regions. A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK. The management and outcomes of women with PAS were compared between the UK and France. Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs. The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus-preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7-6.5 l), compared with 1 l (IQR 0.5-2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: '24 hour' has been changed to 'total' in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage. The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine-conserving approach and more women in the UK undergoing caesarean hysterectomy. A life-threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France.