48 TIMING DELIVERY OF PLACENTA ACCRETA: A DECISION ANALYSIS

Friday, October 19, 2012
The Atrium (Hyatt Regency)
Poster Board # 48
Decision Psychology and Shared Decision Making (DEC)
Candidate for the Lee B. Lusted Student Prize Competition

Merrit A. Hoover, PhD, Shahana Baig-Lewis, Rachel A. Pilliod, BS, Brian L. Shaffer, MD, Elizabeth Munro and Aaron B. Caughey, MD, MPP, MPH, PhD, Oregon Health & Sciences University, Portland, OR

Purpose: To determine the optimal gestational age for delivery in cases of placenta accreta.

Method: A decision-analytic model was designed to compare gestational age of delivery in placenta accreta for gestational ages between 32 and 37 weeks using maternal and fetal quality-adjusted life years (QALY).  At each week of gestational age, we allowed for different delivery strategies: (1) emergent delivery or (2) planned delivery at a predetermined gestational age.  Maternal QALYs were calculated based on the probability of maternal hemorrhage requiring transfusion, hysterectomy, maternal death or uncomplicated delivery; fetal QALYs were calculated based on the probability of developing fetal respiratory distress syndrome (RDS), cerebral palsy (CP), fetal demise or no complications.

Result: Delivery at 34 weeks for women with placenta accreta optimizes maternal and neonatal outcomes, resulting in the greatest likelihood of an uncomplicated delivery.

Conclusion: Delivery at 34 weeks for women with placenta accreta optimizes maternal and fetal outcomes.