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

Abstract

Objective: To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK. Design: Two population-based cohorts. Setting: All obstetrician-led hospitals in the UK and maternity hospitals in eight French regions. Population: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK. Methods: The management and outcomes of women with PAS were compared between the UK and France. Main outcome measures: Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs. Results: 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. Conclusions: 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. Tweetable abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France.