{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:15:06Z","timestamp":1789510506184,"version":"build-2803163510"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:p>\n            Objective\u2003This study compares the number of units of red blood cells (RBCs) transfused in patients with placenta accreta spectrum (PAS) treated with or without a multidisciplinary algorithm that includes placental uterine arterial embolization (P-UAE) and selective use of either immediate or delayed hysterectomy.<\/jats:p><jats:p>\n            Study Design\u2003This is a retrospective study of deliveries conducted at a tertiary care hospital from 2001 to 2018 with pathology-confirmed PAS. Those with previable pregnancies or microinvasive histology were excluded. To improve the equity of comparison, analyses were made separately among scheduled and unscheduled cases, therefore patients were assigned to one of four cohorts as follows: (1) scheduled\/per-algorithm, (2) scheduled\/off-algorithm, (3) unscheduled\/per-algorithm, or (4) unscheduled\/off-algorithm. Primary outcomes included RBCs transfused and estimated blood loss (EBL). Secondary outcomes included perioperative complications and disposition.<\/jats:p><jats:p>\n            Results\u2003Overall, 95 patients were identified, with 87 patients meeting inclusion criteria: 36 treated per-algorithm (30 scheduled and 6 unscheduled) and 51 off-algorithm patients (24 scheduled and 27 unscheduled). Among scheduled deliveries, 9 (30.0%) patients treated per-algorithm received RBCs compared with 20 (83.3%) patients treated off-algorithm (p\u2009&lt;\u20090.01), with a median (interquartile range [IQR]) of 3.0 (2.0, 4.0) and 6.0 (2.5, 7.5) units transfused (p\u2009=\u20090.13), respectively. Among unscheduled deliveries, 5 (83.3%) per-algorithm patients were transfused RBCs compared with 25 (92.6%) off-algorithm patients (p\u2009=\u20090.47) with a median (IQR) of 4.0 (2.0, 6.0) and 8.0 (3.0, 10.0) units transfused (p\u2009=\u20090.47), respectively. Perioperative complications were similar between cohorts.<\/jats:p><jats:p>\n            Conclusion\u2003A multidisciplinary algorithm including P-UAE and selective use of delayed hysterectomy is associated with a lower rate of blood transfusion in scheduled but not unscheduled cases.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0042-1754321","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:50:52Z","timestamp":1660697452000},"page":"1503-1513","source":"Crossref","is-referenced-by-count":16,"title":["Transfusion Requirements with Hybrid Management of Placenta Accreta Spectrum Incorporating Targeted Embolization and a Selective Use of Delayed Hysterectomy"],"prefix":"10.1055","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1821-2258","authenticated-orcid":false,"given":"Luke A.","family":"Gatta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M.","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer B.","family":"Gilner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Gynecologic Oncology, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad A.","family":"Grotegut","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Herbert","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl F.","family":"Pieper","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Ronald","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleska","family":"Pabon-Ramos","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf S.","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle C.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Pathology, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeles Alvarez","family":"Secord","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Gynecologic Oncology, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra H.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina"},{"name":"Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,8,16]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1097\/AOG.0000000000003793","article-title":"Placenta accreta spectrum disorder: uterine dehiscence, not placental invasion","volume":"135","author":"B D Einerson","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3109\/14767058.2015.1034103","article-title":"Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011","volume":"29","author":"M F Mogos","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1097\/AOG.0b013e3181df94e8","article-title":"Regionalization of care for obstetric hemorrhage and its effect on maternal mortality","volume":"115","author":"J D Wright","year":"2010","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"218.e1","DOI":"10.1016\/j.ajog.2014.08.019","article-title":"Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach","volume":"212","author":"A A Shamshirsaz","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"612.e1","DOI":"10.1016\/j.ajog.2017.02.016","article-title":"Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time","volume":"216","author":"A A Shamshirsaz","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1097\/AOG.0000000000002984","article-title":"7: Placenta accreta spectrum","volume":"132","author":"ACOG Obstetric Care Consensus No","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"337.e1","DOI":"10.1016\/j.ajog.2019.05.035","article-title":"Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary 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Alanis","year":"2006","journal-title":"Fertil Steril"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.jvir.2018.12.007","article-title":"Uterine artery embolization following cesarean delivery but prior to hysterectomy in the management of patients with invasive placenta","volume":"30","author":"M Wang","year":"2019","journal-title":"J Vasc Interv Radiol"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/AOG.0000000000002442","article-title":"Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta","volume":"131","author":"A A Shamshirsaz","year":"2018","journal-title":"Obstet Gynecol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum 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