Key result
Maternal outcomes in women with grade 3 PAS varied significantly by country and time period, with postpartum hemorrhage ≥ 3000 mL occurring in 54% of UK women, 25% in France, and 12% in Italy.
Why the study?
Management and outcomes in women with placenta accreta spectrum grade 3 are rarely reported from population-based studies.
Do management strategies and maternal outcomes for placenta accreta spectrum grade 3 vary across different countries and time periods?
Cohort (n=124)
Yes
Do management strategies and maternal outcomes for placenta accreta spectrum grade 3 vary across different countries and time periods?
p-value: p=<0.01
Maternal outcomes and management strategies for grade 3 placenta accreta spectrum varied significantly across the UK, France, and Italy, reflecting differences in prenatal screening and peri-operative management.
International variation in severe PPH for grade 3 PAS highlights care differences; leaves open optimal management strategies for prospective study.
BACKGROUND: Management and outcomes in women with placenta accreta spectrum grade 3 are rarely reported from population-based studies. The objective of this study is to describe profiles, management, and outcomes, of women with placenta accreta spectrum (PAS) grade 3 from three multiperiod studies. METHODS: This analysis used data from three multiperiod population-based cohort studies from the United Kingdom (UK) (May 2010-April 2011), France (November 2013-October 2015), and Italy (September 2014-August 2016) to compare the management and outcomes of women with grade 3 PAS. The main outcome measures were postpartum hemorrhage (PPH) ≥ 3000 mL, blood transfusion ≥ 4 units, and other severe maternal complications (death, damage to bowel or urinary tract). RESULTS: This study included 39 women with PAS grade 3 in the UK, 51 in France, and 34 in Italy, a total of 124 women. PAS was suspected before birth in 59% of the UK cases, 88% in France, and 82% in Italy (P < .01). Conservative management was attempted only in the UK (38%) and in France (61%). PPH ≥ 3000 mL occurred in 54% of the UK women, 25% in France, and 12% in Italy (P < .01); 67% in the UK, 47% in France, and 41% in Italy received blood transfusion ≥ 4 units (P = .06). The final (immediate and secondary) hysterectomy rate differed significantly between the three countries: 69% in the UK, 57% in France, 100% in Italy (P < .01). CONCLUSION: Maternal outcomes in women with grade 3 PAS varied between the three periods and countries, alongside the evolution in prenatal screening and peri-operative management. TRIAL REGISTRATION: For the UK: reference number: RP-PG-0608-10038. For France: reference number: AOR12156. For Italy: reference number: Port. PRE-839/13.
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Pinton et al. (2025) conducted a cohort in Placenta accreta spectrum (PAS) grade 3 (n=124). Country-specific management practices vs. Cross-country comparison (UK vs France vs Italy) was evaluated on Postpartum hemorrhage ≥ 3000 mL (p=<0.01). Maternal outcomes in women with grade 3 PAS varied significantly by country and time period, with postpartum hemorrhage ≥ 3000 mL occurring in 54% of UK women, 25% in France, and 12% in Italy.
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