Placenta Accreta: A New Take on an Old Problem


Paper Presentation

Purpose for the Program

To disseminate information about a multidisciplinary approach to the management of patients with placenta accreta and its variants: increta and percreta. This program will define accreta and its variants and also identify the incidence of accreta in the population. The development of preoperative and intraoperative checklists will be presented along with an in-depth educational plan. The use of erythropoietin and iron sucrose injection also will be discussed.

Proposed Change

To develop a multidisciplinary team, including physicians from the following specialties: obstetrics and gynecology, maternal–fetal medicine, gynecologic oncology, interventional radiology, and urology. Nursing specialties include outpatient nursing and inpatient nursing from the antepartum, labor and delivery, and postpartum units. Nursing experts, such as the clinical nurse specialist, were essential to the team's success.

Implementation, Outcomes, and Evaluation

The first case was scheduled for March with a scheduled patient admission 1-week prior. However, the patient came in before her scheduled admission date because of vaginal bleeding. The bleeding was moderate at the time of admission but became heavy through the night. The team was notified and an emergency cesarean hysterectomy was performed. The patient received 10 units of packed red blood cells. This case, though emergent, went well for this complex patient because of the briefing and preemptive work done by the assembled team of multidisciplinary professionals. To date, five other cases have been scheduled and performed with the use of preoperative and intraoperative checklists, which were developed by nurses. In total, only four units of packed red blood cells have been used subsequently.

Each of these cases has been carefully recorded, including timing of events throughout the case. Each case is briefed to the team to discuss pertinent findings peculiar to the case. Debriefing allows the opportunity for the multidisciplinary team to evaluate and perform a thorough review of the case and discuss what went well and what might be improved.

Implications for Nursing Practice

Consistent nursing practice among all of the nursing specialties was crucial, especially regarding the education plan, which was developed and implemented for each patient by taking into account the individual patient's and family's needs. Preoperative and intraoperative checklists, which were developed by nurses for safety and quality and also validated by the multidisciplinary team, were used for each case. Nurses proved to be critical members of the multidisciplinary team by providing education and quality and safety measures before and during the scheduled case.