724: Morbidly Adherent Placenta - Comparison of Characteristics and Outcomes Between Scheduled and Unscheduled Deliveries Managed Within a Single, Multidisciplinary Team-Based Referral Center

To compare patient outcomes between scheduled and emergent (unscheduled) cesarean hysterectomy for morbidly adherent placenta (MAP) managed by a single multidisciplinary team. Women with pathologically confirmed MAP (placenta accreta, increta or percreta) who underwent surgery by our multidisciplinary MAP team between January 2011 and April 2016 were retrospectively included. Outcome variables were estimated blood loss, units of blood products transfused, ureteric and/or bowel injury and neonatal weight. Comparisons and adjustments were made using appropriate statistical tests. One hundred seven patients were treated for MAP by our team in the study period. Fifty-three (49.5%) underwent scheduled delivery at 34-35 weeks and 54 (50.4%) required unscheduled delivery due to uterine contractions or bleeding at a median of 33 weeks’ gestation. There was one maternal death in the unscheduled group in a patient with extensive percreta who was delivered due to regular contractions, and who developed massive hemorrhage and DIC. There was one case of bowel injury requiring colostomy and delayed reanastomosis in the scheduled group. Baseline characteristics were similar between groups (Table). Thirty nine of 54 (72.2%) patients in the unscheduled group and 44 out of 53 (83.0%) patients in the scheduled group had pathology proven placenta increta or percreta. Although median intraoperative blood loss was not different, the median units of FFP transfused was lower in the scheduled group (P = 0.02) (Table). Unscheduled delivery for MAP is associated with factors such as preoperative bleeding and risk for DIC, that potentially increase the risk of severe morbidity and mortality. In the majority of cases, maternal outcomes are not significantly different in scheduled and unscheduled deliveries when managed by a single multi-disciplinary team. The proportion of patients with placenta accreta (rather than deeper invasion) was higher in the unscheduled group. This suggests that bleeding and/or contractions increase baseline risk despite less invasive disease. There is a moderate increase in neonatal risk (mainly due to prematurity) when unscheduled delivery occurs.