Predictors of ICU Admission in Placenta Accreta Cases

Delivery at an earlier gestational age, recurrent vaginal bleeding, and requirement of emergent delivery are predictors of ICU admission in patients with placenta accreta spectrum, according to a study published in The International Journal of Gynecology & Obstetrics.¹ The presence of all three predictors resulted in a 100% ICU admission rate.

This case-control study focused on placenta accreta spectrum, a severe uterine disorder associated with significant morbidity and mortality, particularly at delivery. The objective was to identify preoperative risk factors for ICU admission following cesarean hysterectomy for placenta accreta and to develop a predictive model for ICU admission with the aim to support patient counseling and resource planning. The study included 145 patients from a referral center underwent cesarean hysterectomy for PAS, which was confirmed by histopathology. The primary study outcome was post-surgery disposition, whether ICU admission vs post-anesthesia care unit. Electronic medical records were utilized to obtain data.

Analysis of data revealed that 63 subjects (43%) required ICU admission post-delivery. ICU-admitted patients were more likely to deliver at an earlier gestational age (34 weeks vs 35 weeks), have more than two episodes of vaginal bleeding and require emergent delivery (44% vs 18.3%) compared to patients with routine recovery care. Logistic regression analysis to establish a predictive model showed a predictive AUC of 0.73 for ICU admission. Of note, patients presenting with all the three risk factors had a 100% ICU admission rate.

The authors emphasize that “resource prediction, utilization, and allocation” pose significant challenges in managing placenta accreta spectrum. They highlight the importance of preoperative identification of risk factors to predict ICU needs. This approach allows healthcare providers to proactively plan for availability and optimize allocation of ICU resources including staffing and enhance patient counseling, thereby improving management of PAS cases.

Reference

1.   Jessian L Munoz, et al. Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum. Int J Gynaecol Obstet. 2024 Nov;167(2):656-662. doi: 10.1002/ijgo.15692.