Placenta accreta spectrum - variations in clinical practice and maternal morbidity between UK and France: a population-based comparative study.
McCall SJ., Deneux-Tharaux C., Sentilhes L., Ramakrishnan R., Collins SL., Seco A., Kurinczuk JJ., Knight M., Kayem G.
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: Two-hundred and nineteen women with PAS in France and one-hundred and thirty-four women 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 litres), postpartum infection and damage to surrounding organs. RESULTS: The management differed between the two countries; a larger proportion of women with PAS in UK had a caesarean hysterectomy compared to France (43% vs. 26%, P<0.001), while in France, a larger proportion of women with PAS had a uterus conserving approach compared to the UK (36% vs. 19%, <0.001). The 24-hour median blood loss in the UK was 3 litres (IQR:1.7-6.5) compared to 1 litre (IQR:0.5-2.5) in France; more women in the UK had a severe PPH compared to women with PAS in France (58% vs. 21%, P<0.001). There was no difference between the UK and French populations for postpartum infection or organ damage. DISCUSSION: UK and France have very different approaches to managing PAS, with more women in France receiving a uterine conserving and more women undergoing caesarean hysterectomy in the UK. 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 healthcare systems.