A new multicountry study has found stunning disparities in maternal outcomes. These results directly apply to women with grade 3 placenta accreta syndrome (PAS). This study was based on research in Italy, the UK, and France. It documented Italy’s exceptional clinical management and outcomes, the entire effort funded by the Italian Ministry of Health. The study combined data from multiple national registries, providing a wide-angle view of treatment patterns in these countries.
Italy came out on top in many important categories. In addition, PPH rates were the lowest in the world at 12%, compared with 54% in the UK and 25% in France. Furthermore, Italy had the lowest transfusion rates at only 41%, versus 67% in the UK and 47% in France. These findings further highlight strong management practices across Italy to care for women presenting with a grade 3 PAS.
Hysterectomy Rates and Clinical Protocols
Perhaps the most surprising result from this study was Italy’s hysterectomy rate – a staggering 100%. This figure is in stark contrast with the United Kingdom’s rate of 62% and France’s 39%. One potential reason that Italy had such a high rate of surgical intervention is that they used standardized hysterectomy protocols.
Italy avoided total hysterectomy in every instance, succeeding in uterine preservation 0% of the time. This choice might account in part for their remarkable results. Italy’s targeted and concentrated approach puts the safety of the patient first and reduces complications. It is truly a testament to this commitment that placenta was not removed in 18% of cases.
“Maternal outcomes in women with grade 3 PAS varied between the three periods and countries, alongside the evolution in prenatal screening, peri-operative management and organisation of care for these women,” – Anne Pinton, Université Paris Cité, INSERM, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France.
Prenatal Detection and Uterine Surgery Rates
The study reported that Italy has the highest prenatal detection rate, at 82%. This rate exceeds the United Kingdom’s 59% and is just behind France’s 88%. This increased detection rate possibly afforded improved preoperative planning and perioperative management strategies.
Italy had a notable prevalence of 50% for previous uterine surgery. The UK was at 15% and France was at 32%. These factors have almost certainly influenced the treatment pathways for those patients who have been diagnosed with grade 3 PAS.
As for complications, Italy had a bowel perforation rate of about every fifth. They still were able to report a remarkable infection rate of 0%, which is a clear indicator of the quality of their peri-operative care processes.
Implications for Future Care
The results from this large multicountry study provide invaluable knowledge that can help guide the management of grade 3 PAS. Italy’s well-established protocols and high rates of prenatal detection can serve as examples of best practice. Similarly, other countries that are struggling with high rates of maternal mortality and morbidity should follow Italy’s example.
The large variations in outcomes all underscore the important need for continued research. Global collaboration is key to improving care for women with this complication everywhere. With the development of healthcare systems, understanding different approaches can help improve maternal care quality around the world.
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