Multidisciplinary Team Approach for Morbidly Adherent Placenta: Maternal Outcomes Compared with Standard Care: Multidisciplinary Team Approach for Morbidly Adherent Placenta

Bushra Iftikhar; Umber Imtiaz Khan; Amera Tariq; Samia Nasreen; Rabiah Anwar; Samina Rehan Khan

doi:10.54393/pjhs.v7i4.3619

Authors

Bushra Iftikhar Department of Obstetrics and Gynecology, Combined Military Hospital, Karachi Institute of Medical Sciences, Karachi, Pakistan
Umber Imtiaz Khan Department of Gynecology and Obstetrics, Combined Military Hospital, Gujranwala, Pakistan
Amera Tariq Department of Gynecology and Obstetrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan
Samia Nasreen Department of Obstetrics and Gynecology, Combined Military Hospital, Karachi Institute of Medical Sciences, Karachi, Pakistan
Rabiah Anwar Department of Gynecology and Obstetrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan
Samina Rehan Khan Department of Gynecology and Obstetrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i4.3619

Keywords:

Morbidly Adherent Placenta, Placenta Accreta Spectrum, Multidisciplinary Team, Obstetric Hemorrhage, Maternal Morbidity, Cesarean Section, Peripartum Hysterectomy

Abstract

Morbidly adherent placenta (MAP), part of the placenta accreta spectrum, is a major cause of severe obstetric hemorrhage and may lead to massive transfusion, peripartum hysterectomy, ICU care, and maternal morbidity. Rising cesarean section rates are increasing the burden of MAP in Pakistan. Multidisciplinary team (MDT) management is proposed to improve preparedness, but outcome benefits remain uncertain. Objective: To compare maternal outcomes in patients with MAP managed by an MDT versus standard obstetric care. Methods: A comparative, non-randomized observational study was conducted at the Department of Obstetrics and Gynecology, Pakistan Navy Ship Shifa Hospital, Karachi, from February 2022 to July 2022, vide Ethical Committee PNS Shifa approval. A total of 151 women diagnosed with MAP were included. Outcomes included maternal morbidity, estimated blood loss (EBL), transfusion requirement, time to intervention, hospital stay, and surgical procedures. Results: Overall mean EBL was 512.24 mL, and mean transfusion requirement was 1.91 units. Compared with standard care, MDT management showed no significant differences in EBL (p=0.300), transfusion units (p=0.237), time to intervention (p=0.426), or hospital stay (p=0.926). Maternal morbidity and major surgical interventions were also comparable between groups. Conclusions: MDT-based care showed no significant improvement in blood loss, transfusion needs, or maternal morbidity compared with standard care.

References

Ma Y and Ma J. Global Guidelines on Placenta Accreta Spectrum Disorders: A Commentary from the Chinese Perspective. Maternal-Fetal Medicine. 2023 Jan: 10-97.

Selby Chacko K, AlSubeaei RS, Sunil Nair S, Khalil Kazi N, Jeddy R. Maternal and Clinical Outcomes of Placenta Accreta Spectrum: Insights from A Retrospective Study in Bahrain. Life. 2025 Jun; 15(6): 978. doi: 10.3390/life15060978. DOI: https://doi.org/10.3390/life15060978

Bartels HC, Walsh JM, Mhuircheartaigh R, Brophy D, Moriarty J, Geoghegan T et al. National Clinical Practice Guideline: Diagnosis and Management of Placenta Accreta Spectrum. Dublin: National Women Infants' Health Program Inst Obstetrics and Gynaecology. 2022: 45-53.

Bonanni G, Lopez-Giron MC, Allen L, Fox K, Silver RM, Hobson SR et al. Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review. Journal of the American Medical Association Network Open. 2025 Jul; 8(7): e2521909. doi: 10.1001/jamanetworkopen.2025.21909. DOI: https://doi.org/10.1001/jamanetworkopen.2025.21909

Sugai S, Yamawaki K, Sekizuka T, Haino K, Yoshihara K, Nishijima K. Comparison of Maternal Outcomes and Clinical Characteristics of Prenatally vs Nonprenatally Diagnosed Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine. 2023 Dec; 5(12): 101197. doi: 10.1016/j.ajogmf.2023.101197. DOI: https://doi.org/10.1016/j.ajogmf.2023.101197

Shainker SA, Coleman B, Timor-Tritsch IE, Bhide A, Bromley B, Cahill AG et al. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on Definition of Markers and Approach to the Ultrasound Examination in Pregnancies at Risk for Placenta Accreta Spectrum. American Journal of Obstetrics and Gynecology. 2021 Jan; 224(1): B2-14. doi: 10.1016/j.ajog.2020.09.001. DOI: https://doi.org/10.1016/j.ajog.2020.09.001

Lersten IL, Rodriguez CE, Gilroy JR, Fink DM, Guntupalli SR. A Quality Improvement Initiative to Decrease Maternal Morbidity in Placenta Accreta Spectrum with a Standardized Approach: A Single Institution Experience. Annals of Gynaecology and Obstetrics. 2021 Jan; 5(1). doi: 10.36959/468/475. DOI: https://doi.org/10.36959/468/475

Yao R, Nguyen HY, Hong L, Martin C, Balli K, Ioffe Y. Impact of a Multidisciplinary Team Approach on the Diagnosis and Management of Placenta Accreta Spectrum Disorder [A228]. Obstetrics and Gynecology. 2022 May; 139: 66S. doi: 10.1097/01.AOG.0000826188.07859.39. DOI: https://doi.org/10.1097/01.AOG.0000826188.07859.39

Yao R, Nguyen HY, Hong L, Karagoyzyan D, Burruss S, Brar H et al. Regional Multidisciplinary Team Approach to the Management of Placenta Accreta Spectrum Disorder. The Journal of Maternal-Fetal and Neonatal Medicine. 2023 Dec; 36(1): 2190840. doi: 10.1080/14767058.2023.2190840. DOI: https://doi.org/10.1080/14767058.2023.2190840

Basri S and Jahdali E. Maternal Outcomes After Placenta Previa and Its Spectrum at a Single Saudi Academic Tertiary Care Center: 21-Year Experience. Journal of Complementary Medicine Research. 2022; 13(4): 98-102. doi: 10.5455/jcmr.2022.13.04.20. DOI: https://doi.org/10.5455/jcmr.2022.13.04.20

Yuliantara EE, Bachnas MA, Anggraini NW, Prabowo W, Nugraha GB, Chasanah MD et al. Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder. Placentum: Jurnal Ilmiah Kesehatan dan Aplikasinya. 2023; 11(2): 155-65. doi: 10.20961/placentum.v11i2.71047. DOI: https://doi.org/10.20961/placentum.v11i2.71047

Rehman S, Bilqis H, Deeba F, Sheyryar S, Urooj A, Khan S. Morbidly Adherent Placenta: A Cross-Sectional Study in A Tertiary Care Hospital. Pakistan Journal of Medicine and Dentistry. 2022; 11(4): 50-4.

Parveen F, Aijaz S, Memon SA, Memon FN, Enayat R. Maternal Outcomes in the Management of Morbidly Adherent Placenta: Multidisciplinary Team vs. Standard Care at a Tertiary Care Hospital. Pakistan Journal of Medical Research. 2021 May; 60(1): 2-7.

Zhou H, Wang W, Gu N, Li Q, Qiu L, Zhu Z et al. Improved Maternal Outcome in Placenta Accreta Spectrum Disorders: A Single-Institute Observational Cohort Study. BioMed Central Pregnancy and Childbirth. 2025 Dec; 25(1): 1231. doi: 10.1186/s12884-025-08435-w. DOI: https://doi.org/10.1186/s12884-025-08435-w

Bartels HC, Mulligan KM, Craven S, Rogers AC, Higgins S, O’Brien DJ et al. Maternal Morbidity in Placenta Accreta Spectrum Following Introduction of a Multi-Disciplinary Service Compared to Standard Care: An Irish Perspective. Irish Journal of Medical Science (1971-). 2021 Nov; 190(4): 1451-7. doi: 10.1007/s11845-020-02473-3. DOI: https://doi.org/10.1007/s11845-020-02473-3

Zhang J, Li H, Feng D, Wu J, Wang Z, Feng F. Ultrasound Scoring System for Prenatal Diagnosis of Placenta Accreta Spectrum. BioMed Central Pregnancy and Childbirth. 2023 Aug; 23(1): 569. doi: 10.1186/s12884-023-05886-x. DOI: https://doi.org/10.1186/s12884-023-05886-x

Teixeira B, Pinto PV, Realista R, Silva M, Costa A, Machado AP et al. Placenta Accreta Spectrum Disorders–The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal. Revista Brasileira de Gynecology and Obstetrics. 2023 Dec; 45(12): e747-53. doi: 10.1055/s-0043-1772482. DOI: https://doi.org/10.1055/s-0043-1772482

Luder A, Castel E, Kleinmann N, Mazaki-Tovi S, Lahav-Ezea H, Shvero A et al. Multidisciplinary Protocol and Outcomes in Placenta Accreta Spectrum: A 12-Year Cohort Study. Archives of Gynecology and Obstetrics. 2026 Feb; 313(1): 80. doi: 10.1007/s00404-025-08263-5. DOI: https://doi.org/10.1007/s00404-025-08263-5

Muadtongon K, Rattanaburi A, Ajimakul T, Suphasynth Y, Jiamset I, Nantamongkolkul K et al. Successful Multidisciplinary Team Management of Placenta Accreta Spectrum Disorder: A Referral Center Model in a Middle‐Income Country. International Journal of Gynecology and Obstetrics. 2024 May; 165(2): 813-22. doi: 10.1002/ijgo.15339. DOI: https://doi.org/10.1002/ijgo.15339

Rajoriya D, Dubey D, Gandhi D, Agarwal D. Maternal and Fetal Outcome of Morbidly Adherent Placenta in a Tertiary Care Institute: A Retrospective One-Year Study. International Journal. 2020; 4(4): 290-2. doi: 10.33545/gynae.2020.v4.i4e.660. DOI: https://doi.org/10.33545/gynae.2020.v4.i4e.660