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Am J Perinatol 2023; 40(16): 1738-1744
DOI: 10.1055/a-2126-7337
SMFM Fellowship Series Article

Risk of Severe Maternal Morbidity in Patients with Placenta Accreta Spectrum Disorders Referred from Rural Communities to a Regional Placenta Accreta Spectrum Center

Jessian L. Munoz 
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Balor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Patrick S. Ramsey
2   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Texas Health Sciences Center at San Antonio and University Health System, San Antonio, Texas
,
John J. Byrne
2   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Texas Health Sciences Center at San Antonio and University Health System, San Antonio, Texas
› Author Affiliations Funding None.
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Abstract

Objective The primary objective of this study was to assess the risk of severe maternal morbidity (SMM) experienced by patients residing in rural communities when delivered by a multidisciplinary team within a single urban academic center for placenta accreta spectrum (PAS). Subsequently, we aimed to determine a distance-dependent relationship between PAS morbidity and distance travelled by patients in rural communities.

Study Design This was a retrospective cohort study of patients who had PAS histopathological confirmation and delivery at our institution from 2005 to 2022. Our objective was to determine the relationship between patient locations (rural vs. urban) and maternal morbidity associated with PAS delivery. Sociogeographic determination of rurality was determined using the National Center for Health Statistics and most recent national census population data. Distance travelled was calculated by patient zip code to our PAS center using global positioning system data.

Results During the study period, 139 patients were managed by cesarean hysterectomy with confirmed PAS histopathology. Of these, 94 (67.6%) were from our urban community and 45 (32.4%) were from surrounding rural communities. The overall SMM incidence was 85% including blood transfusion and 17% without blood transfusions. Patient from rural communities were more likely to experience SMM (28.9 vs. 12.8%, p = 0.03) and this was driven by acute renal failure (1.1 vs. 11.1%, p = 0.01) and disseminated intravascular coagulopathy (1.1 vs. 8.8%, p = 0.04). SMM did reveal a distance-dependent relationship with SMM rates of 13.2, 33.3, and 43.8% at 50, 100, and 150 miles, respectively (p = 0.005).

Conclusion Patients with PAS experience high rates of SMM. Geographic distance to a PAS center appears to significantly impact the overall morbidity a patient experiences. Further research is warranted to address this disparity and optimize patient outcomes for patients in rural communities

Key Points

  • Patients from rural communities experience greater SMM in the setting of PAS.

  • Intraoperative outcomes and interventions were similar, regardless of patient location.

  • SMM may be related to the distance travelled by patients in rural communities.

Keywords

placenta accreta - cesarean hysterectomy - abnormal placentation


Publication History

Received: 31 August 2022

Accepted: 07 July 2023

Accepted Manuscript online:
11 July 2023

Article published online:
09 August 2023

© 2023. Thieme. All rights reserved.

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