Knowledge Gaps in Placenta Accreta Spectrum

Since its first description early in the 20th Century, placenta accreta and its variants have changed substantially in incidence, risk factor profile, clinical presentation, diagnosis and management. While systematic use of diagnostic tools and a multidisciplinary team care approach has begun to improve patient outcomes, the condition's pathophysiology, epidemiology, and best practices for diagnosis and management remain poorly understood. The use of large databases with broadly accepted terminology and diagnostic criteria should accelerate research in this area. Future work should focus on non-traditional phenotypes, such as those without placenta previa-preventive strategies, and long term medical and emotional support for patients facing this diagnosis. KEY POINTS: · Placenta accreta spectrum research may be improved with standardized terminology and use of large databases.. · Placenta accreta prediction should move beyond ultrasound with the addition of biomarkers, and needs to extend to those without traditional risk factors.. · Future research should identify practices that can prevent future accreta development..

Engaging pregnant individuals and healthcare professionals in an international mixed methods study to develop a core outcome set for studies on placenta accreta spectrum disorder (COPAS): a study protocol

INTRODUCTION

Placenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals at high risk of major haemorrhage during the third stage of labour. Current research reports on PAS disorder outcomes have highly variable levels of information, which is therefore difficult for investigators to aggregate to inform practice. There is an urgent need to harmonise data collection in prospective studies to identify and implement best practices for management. One approach to standardise outcomes across any health area via the use of core outcome sets (COSs), which are consensus-derived standardised sets of outcomes that all studies for a particular condition should measure and report. This protocol outlines the steps for developing a COS for PAS disorder (COPAS).

METHODS AND ANALYSIS

This protocol outlines steps for the creation of COPAS. The first step, a systematic review, will identify all reported outcomes in the scientific literature. The second step will use qualitative one-on-one interviews to identify additional outcomes identified as important by patients and healthcare professionals that are not reported in the published literature. Outcomes from the first two steps will be combined to form an outcome inventory. This outcome inventory will inform the third step which is a Delphi survey that encourages agreement between patients and healthcare professionals on which outcomes are most important for inclusion in the COS. The fourth step, a consensus group meeting of representative participants, will finalise outcomes for inclusion in the PAS disorder COS.

ETHICS AND DISSEMINATION

This study has obtained Research Ethics Board approval from Sunnybrook Health Sciences Centre (#2338, #1488). We will aim to publish the study findings in an international peer-reviewed OBGYN journal.

REGISTRATION DETAILS

COMET Core Outcome Set Registration: https://www.comet-initiative.org/Studies/Details/1127.

PROSPERO REGISTRATION NUMBER

CRD42020173426.

Women's experiences of skin-to-skin cesarean birth compared to standard cesarean birth: a qualitative study

BACKGROUND

Skin-to-skin contact between mother and infant immediately after birth is recommended regardless of delivery method; however, it is less common after cesarean delivery. We aimed to describe and compare women's experiences of cesarean birth with and without skin-to-skin contact at an urban tertiary care hospital.

METHODS

In this hermeneutic phenomenologic study, we used semistructured telephone interviews from 2015 to 2018 to interview a convenience sample of women who delivered at term by scheduled skin-to-skin cesarean birth at an urban tertiary care hospital in Toronto, Ontario. Women were invited to participate if they had had a previous planned or unplanned cesarean birth and a scheduled skin-to-skin cesarean birth between 2013 and 2017. Participants were excluded if they had antenatally diagnosed conditions, they delivered before 37 weeks, they had general anesthesia, their condition was unstable at the time of surgery, a skin-to-skin cesarean birth was not possible or they declined skin-to-skin cesarean birth. Interviews were recorded, transcribed and analyzed by means of thematic analysis.

RESULTS

Ten women were interviewed 1-19 months postpartum. Four central themes emerged: support for skin-to-skin cesarean birth (women feeling supported by their families and health care providers); control (participants experiencing greater control during their skin-to-skin cesarean birth); connection with the infant, which enabled women to be active participants in their delivery, enhanced bonding and intimacy, facilitated breastfeeding and bolstered confidence during early parenthood; and logistic considerations, with participants recognizing that skin-to-skin cesarean birth required additional resources.

INTERPRETATION

These findings refine what is known about skin-to-skin cesarean birth and provide a critical perspective, that of mothers. They support the transformation of traditional operating room dynamics to a more patient-centred environment.

Co-occurring intimate partner violence, mental health, and substance use problems: a scoping review

Background

Intimate partner violence (IPV) is a pervasive, serious problem detrimental to the health of untold numbers of women. In addition to physical injuries that may be sustained, IPV has been significantly associated with mental health challenges including substance use problems. The problems are complex, highly correlated with each other, and bidirectional in nature. Although as many as 50% of women in mental health and between 25% and 50% of women in substance abuse treatment programs report IPV, frontline workers in all three sectors state they lack the training to address these co-occurring problems.

Objective

To determine what frontline IPV, mental health, and substance use workers need to know in order to provide appropriate care to women experiencing co-occurring IPV, mental health and/or substance use problems.

Design

Using Scholars Portal OVID, Medline and OVID PsycINFO and combinations of significant terms, we conducted a scoping review of articles published between 2005 and 2014.

Results

An initial 4017 records were retrieved (3484 from Scholars Portal, 272 from Medline, 261 from PsycINFO). After applying inclusion and exclusion criteria, 35 articles were reviewed. Of these, 14 examined the relationships among IPV, mental health, and substance use; 7 focused on IPV and mental health; 14 looked at IPV and substance use.

Conclusions

Although education and training frequently figured among the recommendations in the reviewed articles, specific content for proposed education or training was lacking. The most frequently occurring recommendations focused on the need to develop better collaboration, coordination, and integration across IPV, mental health and addiction treatment services.