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Cited by 38Maternal and fetal healthcareBlood transfusion and managementUterine Myomas and Treatments

Placenta accreta spectrum – variations in clinical practice and maternal morbidity between the UK and France: a population‐based comparative study

Open access
McCall, Stephen J., Deneux‐Tharaux, Catherine, Sentilhes, Loïc, Ramakrishnan, Rema, Collins, Sally L., Seco, Aurélien, Kurinczuk, Jennifer J., Knight, Marian +1 more·2022·BJOG: An International Journal of Obstetrics & Gynaecology
DOI 10.1111/1471-0528.17169PMC PMC9544707
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Abstract

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: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS 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 l), postpartum infection and damage to surrounding organs. Results: The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus‐preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7–6.5 l), compared with 1 l (IQR 0.5–2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: ‘24 hour’ has been changed to ‘total’ in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage. Conclusions: The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine‐conserving approach and more women in the UK undergoing caesarean hysterectomy. 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 the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Tweetable abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France.

AI snapshot

Written from the paper’s full text.

TL;DR

This binational population-based study compared management and maternal outcomes of placenta accreta spectrum (PAS) in the UK and France. French women more often received uterus-preserving management, while UK women more often underwent caesarean hysterectomy and experienced substantially greater blood loss and severe postpartum haemorrhage.

Key findings

  • UK women with PAS were more likely to have caesarean hysterectomy than French women (43% vs 26%, p < 0.001), whereas French women were more likely to receive a uterus-preserving approach (36% vs 19%, p < 0.001).
  • Median total blood loss was 3050 ml (IQR 1700–6500 ml) in the UK versus 1000 ml (IQR 500–2500 ml) in France (p < 0.001); severe postpartum haemorrhage (≥3000 ml) occurred in 58% vs 21% (p < 0.001).
  • UK women more often received red blood cell transfusion (76% vs 51%, p < 0.001), massive transfusion (≥6 units: 64% vs 49%, p = 0.028), and ITU admission (69% vs 30%, p < 0.001).
  • There was no significant difference between countries in postpartum infection (2% vs 1%, p = 0.332), damage to bowel/urinary tract/bladder (7.5% vs 7.9%, p = 0.889), or perinatal mortality (p = 0.759).

Methods

  • Binational population-based secondary analysis using UKOSS data from the UK (May 2010–April 2011; 798,634 maternities) and PACCRETA data from eight French regions (November 2013–October 2015; 176 centres; 520,114 maternities).
  • A harmonised case definition was created by selecting French women who met the stricter UKOSS definition; the study compared characteristics, management, and maternal/infant outcomes between countries.
  • Analyses used Student’s t-test, Wilcoxon rank-sum, Kruskal–Wallis, chi-square or Fisher’s exact tests, with sensitivity analyses restricted to placenta percreta, antenatally suspected PAS, and antenatally detected placenta praevia; French women without PPH had blood loss imputed as 500 ml.

Limitations

  • The paper states that the UK and French studies had different case definitions, so even after harmonisation the populations may have differed, and the UK study may have comprised more severe PAS cases.
  • The paper states that PAS management has changed since these data were collected, so the findings may not reflect current practice; a randomised controlled trial was considered difficult in this setting.
  • Evident from the text: the abstract reports a UK cohort of 154 women, whereas the results and tables report 134 UK women; the observational cross-country design cannot establish causality, and the UK and French data were collected in different time periods.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/1471-0528.17169

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 35 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In both the UK and France, approximately half of the women had PAS suspected prior to delivery.

    “In both the UK and France, approximately half of the women had PAS suspected prior to delivery.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.
  • Findingown data

    There was no difference between the UK and French populations for organ damage.

    “There was no difference between the UK and French populations for postpartum infection or organ damage.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.
    • Rests on an assumption: The French data on postpartum infection and organ damage, based on specific questions, are comparable to the UK data extracted from free-text responses.
  • Findingown data

    A larger proportion of women with PAS in France received a uterus-preserving approach compared with the UK (36% vs 19%, p < 0.001).

    “in France a larger proportion of women with PAS received a uterus‐preserving approach compared with the UK (36% vs 19%, p < 0.001)”
    • Also stated in: § PAS management · plain
      “a lower proportion of women had their placenta left in situ in the UK compared with France (19% vs 36%, p < 0.001)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.
  • Findingown data

    There was no difference between the UK and French populations for postpartum infection.

    “There was no difference between the UK and French populations for postpartum infection or organ damage.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.
    • Rests on an assumption: The French data on postpartum infection and organ damage, based on specific questions, are comparable to the UK data extracted from free-text responses.
  • Findingown data

    In women who had PAS and had a previous pregnancy, a statistically significantly higher proportion in the UK had at least one previous caesarean section compared with France (93% vs 80%, p = 0.003).

    “In women who had PAS and had a previous pregnancy, a statistically significantly higher proportion of women in the UK had at least one previous caesarean section compared with women in France (93% vs 80%, p = 0.003)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.
  • May combine two claims. 23
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingown data

    In women that had placenta left in situ, approximately one-third of women in the UK and one-fifth of women in France went on to have a hysterectomy.

    “In women that had placenta left in situ, approximately one‐third of women in the UK and one‐fifth of women in France went on to have a hysterectomy.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The total median blood loss in the UK was 3 l (IQR 1.7-6.5 l), compared with 1 l (IQR 0.5-2.5 l) in France.

    “The total median blood loss in the UK was 3 l (IQR 1.7–6.5 l), compared with 1 l (IQR 0.5–2.5 l) in France”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.

  • May combine two claims.

    Findingown data

    In the UK, over three-quarters of women (76%) had an attempted manual removal of the placenta, whereas this occurred for 68% of women in France (p < 0.001).

    “In the UK, over three‐quarters of women (76%) had an attempted manual removal of the placenta, whereas this occurred for 68% of women in France (p < 0.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.

  • May combine two claims.

    Findingown data

    The majority of women with PAS were managed with planned hysterectomy in the UK, while in France a left in situ approach to conserve the uterus was more commonly attempted.

    “In particular, the majority of women with PAS were managed with planned hysterectomy in the UK, while in France, a left in situ approach to conserve the uterus was more commonly attempted.”
    • Also stated in: § Interpretation · plain
      “Similar to previous findings, this study showed that the primary management for PAS in the UK was peripartum hysterectomy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Nearly two-thirds of women with PAS in the UK had a massive blood transfusion, compared with half in France (64% vs 49%, p=0.028).

    “Nearly two‐thirds of women in the UK with PAS had a massive blood transfusion, compared with half of the women with PAS in France (64% vs 49%, p = 0.028).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Over half of women with PAS in the UK had severe PPH ≥3000 ml, whereas only a fifth in France did (p<0.001).

    “Over half of the women with PAS in the UK had a severe PPH of ≥3000 ml, whereas only a fifth of women in France experienced this level of haemorrhage (p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Approximately three-quarters of women with PAS in the UK received an RBC transfusion, whereas half in France did (p<0.001).

    “Approximately three‐quarters of women with PAS received an RBC transfusion in the UK, whereas half of women received an RBC transfusion in France (p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    One-fifth of women in France with conservative management had a delayed hysterectomy, and these women had severe blood loss.

    “as one‐fifth of women in France with conservative management had a delayed hysterectomy, and these women had severe blood loss.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A common case definition was devised to provide a harmonised data set of women with PAS, which involved selecting women in France that met the stricter UKOSS definition.

    “A common case definition was devised to provide a harmonised data set of women with PAS, which involved selecting women in France that met the stricter UKOSS definition”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    PAS becomes a clinical problem after birth, when the placenta does not physiologically detach from the uterus and the forcible removal of the placenta is followed by massive obstetric haemorrhage (MOH), leading to further morbidity and risk of maternal death.

    “PAS becomes a clinical problem after birth, when the placenta does not physiologically detach from the uterus and the forcible removal of the placenta is followed by massive obstetric haemorrhage (MOH), leading to further morbidity and risk of maternal death.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Committee on obstetric practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol. 2012; 120(1): 207. 22914422 source

      Not checked in the free run.

    • cites [3] Fitzpatrick K, Sellers S, Spark P, Kurinczuk J, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study. BJOG. 2014; 121(1): 62– 71. PMC3906842 23924326 source

      Not checked in the free run.

    • cites [4] Saucedo M, Deneux‐Tharaux C, Bouvier‐Colle M‐H. Ten years of confidential inquiries into maternal deaths in France, 1998–2007. Obstet Gynecol. 2013; 122(4): 752– 60. 24084531 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sensitivity analyses were undertaken to assess results in subpopulations, including women who had placenta percreta, women with PAS suspected antenatally and women with placenta praevia detected antenatally.

    “Sensitivity analyses were undertaken to assess results in subpopulations, which included women who had placenta percreta, women with PAS suspected antenatally and women with placenta praevia detected antenatally.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Caesarean hysterectomy is considered the standard approach for managing PAS.

    “Caesarean hysterectomy is considered the standard approach for managing PAS, 11 , 18 and forms the mainstay of the management of PAS for many authorities and clinicians internationally, including in the UK.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Eller A, Porter T, Soisson P, Silver R. Optimal management strategies for placenta accreta. BJOG. 2009; 116(5): 648– 54. 19191778 source

      Not checked in the free run.

    • cites [18] Sentilhes L, Kayem G, Chandraharan E, Palacios‐Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynecol Obstet. 2018; 140(3): 291– 8. 29405320 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    UK guidelines recommend caesarean hysterectomy as the standard management and leaving the placenta in situ only for women desiring uterine preservation or when the surgical team considers caesarean hysterectomy inappropriate.

    “the UK guidelines recommend caesarean hysterectomy as the standard management and leaving the placenta in situ only for women desiring uterine preservation or when the surgical team considers caesarean hysterectomy inappropriate.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Jauniaux E, Alfirevic Z, Bhide A, Belfort M, Burton G, Collins S, et al. Placenta praevia and placenta accreta: diagnosis and management: green‐top guideline No. 27a. BJOG. 2019; 126(1): e1– e48. 30260097 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Placenta increta and placenta accreta are often largely indistinguishable clinically.

    “on the basis that placenta increta and placenta accreta are often largely indistinguishable clinically”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    This binational study showed that management and maternal outcomes were different between the two cohorts of women with PAS in the UK and France, despite similar proportions of placenta percreta and antenatally suspected cases.

    “This binational study has shown that the management and maternal outcomes were different between the two cohorts of women with PAS in the UK and France, despite having similar proportions of placenta percreta and antenatally suspected cases of PAS.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Ruiz and Chen have shown that there were higher complication, transfusion and mortality rates for hysterectomies performed by inexperienced surgeons compared with experienced surgeons.

    “Ruiz and Chen 36 have shown that there were higher complication, transfusion and mortality rates for hysterectomies performed by inexperienced surgeons compared with experienced surgeons.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Ruiz MP, Chen L, Hou JY, Tergas AI, St CC, Ananth CV, et al. Outcomes of hysterectomy performed by very low‐volume surgeons. Obstet Gynecol. 2018; 131: 981– 90. 29742669 PMC5970072 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Caesarean hysterectomy has been shown to be a life-saving treatment for women where other uterus-conserving surgeries fail.

    “Previous studies have shown caesarean hysterectomy to be a life‐saving treatment for women where other uterus‐conserving surgeries fail.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol. 2010; 202(1): 38.e1– 9. 19922901 source

      Not checked in the free run.

    • cites [20] Knight M, UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007; 114(11): 1380– 7. 17877772 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These previous studies were not population-based and lacked an appropriate comparison group.

    “However, these studies were not population‐based and lacked an appropriate comparison group.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010; 115(3): 526– 34. 20177283 source

      Not checked in the free run.

    • cites [33] Pather S, Strockyj S, Richards A, Campbell N, Vries B, Ogle R. Maternal outcome after conservative management of placenta percreta at caesarean section: a report of three cases and a review of the literature. Aust N Z J Obstet Gynaecol. 2014; 54(1): 84– 7. 24471850 source

      Not checked in the free run.

    • cites [34] Clausen C, Lönn L, Langhoff‐Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand. 2014; 93(2): 138– 43. 24266548 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Previous studies have shown that women had preserved future fertility and reduced haemorrhage risk when PAS was managed conservatively.

    “Previous studies have shown that women had preserved future fertility and reduced haemorrhage risk when PAS was managed conservatively.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod. 2010; 25: 2803– 10. 20833739 PMC3413618 source

      Not checked in the free run.

    • cites [21] Kayem G, Davy C, Goffinet F, Thomas C, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol. 2004; 104(3): 531– 6. 15339764 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Some women with placenta left in situ had no histological uterine examination when a hysterectomy was avoided.

    “because some women with placenta left in situ had no histological uterine examination when a hysterectomy was avoided.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Uterine-preserving management may have resulted in a greater number of women retaining their potential fertility and reduced the likelihood of a life-threatening haemorrhagic event.

    “Uterine‐preserving management may have resulted in a greater number of women retaining their potential fertility and reduced the likelihood of a life‐threatening haemorrhagic event.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The data from these two studies may not reflect current practice, yet these data illustrate that differences in health system-affected outcomes for women with PAS.

    “It should be noted that the data from these two studies may not reflect current practice, yet these data illustrate that differences in health system‐affected outcomes for women with PAS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies have highlighted issues with subclassifying PAS.

    “Studies have highlighted issues with subclassifying PAS; as a result, future prospective studies should use the International Federation of Gynaecology and Obstetrics (FIGO) guidelines and current evidence to allow for accurate subclassification, harmonisation and comparability.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Jauniaux E, Ayres‐de‐Campos D, Langhoff‐Roos J, Fox KA, Collins S, Diagnosis FPA, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynecol Obstet. 2019; 146(1): 20– 4. 31173360 source

      Not checked in the free run.

    • cites [40] Jauniaux E, Hecht JL, Elbarmelgy RA, Elbarmelgy RM, Thabet MM, Hussein AM. Searching for placenta Percreta: a prospective cohort and systematic review of case reports. Am J Obstet Gynecol. 2021. 10.1016/j.ajog.2021.12.030 34973177 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Both the UK and French studies had different case definitions, so even with considerable effort to harmonise the definitions, it was possible that the populations slightly differed.

    “Both the UK and French studies had different case definitions, so even with considerable effort to harmonise the definitions of the two studies it was possible that the populations slightly differed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A potential explanation for the difference in blood loss may be the result of differences in the healthcare system.

    “Thus, a potential explanation for the difference in blood loss may be the result of differences in the healthcare system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    It may be that the UK study comprised more severe cases of PAS compared with the French study, which could be a potential explanation for the differences in incidence.

    “It may be that the UK study comprised more severe cases of PAS compared with the French study, which could be a potential explanation for the differences in incidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    This may have led to varying levels of confidence in the PAS diagnosis between France and the UK, where the manual attempted removal of the placenta was performed more readily in the UK compared with France.

    “This may have led to varying levels of confidence in the PAS diagnosis between France and the UK, where the manual attempted removal of the placenta was performed more readily in the UK compared with France.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Obstetricians and radiologists perform the majority of antenatal imaging in France, whereas a midwife or sonographer performs these scans in the UK.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    This difference may be the result of differences in clinical practice or the structure of the health care system.

    “This may be the result of differences in clinical practice or the structure of the health care system.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Without a rupture, failed conservative management or trauma to the uterus, there is less likely to be a spontaneous haemorrhage, whereas even a planned hysterectomy for placenta percreta is likely to result in major blood loss.

    “Without a rupture, failed conservative management or trauma to the uterus, there is less likely to be a spontaneous haemorrhage, 18 whereas even a planned hysterectomy for placenta percreta is likely to result in major blood loss.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Sentilhes L, Kayem G, Chandraharan E, Palacios‐Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynecol Obstet. 2018; 140(3): 291– 8. 29405320 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    A randomised controlled trial is the most robust method to examine the causal effect of management on outcomes, but this would be difficult to conduct in this clinical scenario.

    “A randomised controlled trial is the most robust method to examine the causal effect of management on outcomes, but this would be difficult to conduct in this clinical scenario.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Women who had modified radical peripartum caesarean hysterectomy conducted by highly skilled and experienced surgical teams had better outcomes compared with normal surgical approaches; accordingly, the experience and skill set of the surgical team matters.

    “Colleagues have shown that women who had modified radical peripartum caesarean hysterectomy conducted by highly skilled and experienced surgical teams had better outcomes compared with normal surgical approaches; accordingly, the experience and skill set of the surgical team matters.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Collins SL, Addley S, Weeks E, Chakravarti S, Halder S, Alazzam M. The modified radical peripartum cesarean hysterectomy (Soleymani‐Alazzam‐Collins technique): a systematic, safe procedure for the management of severe placenta accreta spectrum. Am J Obstet Gynecol. 2021; 225(2): 175.e1– 175.e10. 10.1016/j.ajog.2021.03.014 33716074 source

      Not checked in the free run.

31 of 31

  • The paper relies on this without support.

    The eight French regions included in PACCRETA are representative of France as a whole for PAS management and outcomes.

    “from 176 centres across eight regions of France, where there were 520 114 maternities, which represents 30% of the national total over the study period.”

  • The paper relies on this without support.

    The UKOSS data from May 2010 to April 2011 and the French PACCRETA data from November 2013 to October 2015 are comparable despite being collected in different time periods.

    “women meeting the case definition were identified nationally in the UK during the period from May 2010 to April 2011”
    “this population‐based study identified women meeting the case definition (Table 1) during the period from November 2013 to October 2015”

  • The paper relies on this without support.

    The French data on postpartum infection and organ damage, based on specific questions, are comparable to the UK data extracted from free-text responses.

    “Postpartum infection and damage to the surrounding organs were extracted from free‐text responses to the question of ‘did woman have any other morbidity?’ in the UK, and the French data were based on specific questions.”

  • The authors state this as an assumption.

    The complexity of surgery is the same for women in France and the UK.

    “Assuming that the complexity of surgery is the same for women in France and the UK”

  • The paper relies on this without support.

    Obstetricians and radiologists perform the majority of antenatal imaging in France, whereas a midwife or sonographer performs these scans in the UK.

    “obstetricians and radiologists perform the majority of antenatal imaging in France, whereas a midwife or sonographer performs these scans in the UK.”

  • The paper relies on this without support.

    The UK health system has yet to centralise PAS management into multidisciplinary teams that regularly perform complex surgeries for PAS.

    “Although planned, the UK health system has yet to centralise PAS management into multidisciplinary teams that regularly perform complex surgeries for PAS.”

  • The paper relies on this without support.

    PAS care was centralised into specialist centres in France.

    “In contrast, PAS care was centralised into specialist centres in France”

  • The paper relies on this without support.

    After delivery, blood flow to the uterus decreases, resulting in necrosis of the placenta and either expulsion or reabsorption of the placenta.

    “After delivery, the blood flow to the uterus decreases, which will result in necrosis of the placenta and either expulsion or reabsorption of the placenta.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Centres practicing conservative management with leaving the placenta in situ may have much lower hysterectomy rates compared to centres where hysterectomy is routinely performed for PAS cases.

    “centres practicing conservative management with leaving the placenta in situ may have much lower hysterectomy rates compared to centres where hysterectomy is routinely performed for PAS cases [22, 38]”

    From Radiomics-based prediction of FIGO grade for placenta accreta spectrum (2023) · cites this paper as [38]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • UK cohort size differs between abstract and results

    Major

    The abstract reports 154 UK women with PAS, but the results and tables report 134.

  • Planned hysterectomy was not used for a majority of UK women

    Major

    The discussion says a majority of UK women with PAS were managed with planned hysterectomy. Table 3 reports only 38 planned hysterectomies among 134 UK women-less than a third of the cohort, and less than half of those who had a hysterectomy.

  • UK perinatal mortality percentage is overstated

    Minor

    There were 2 perinatal deaths among 134 UK infants with nonmissing outcomes (138 infants minus 4 missing), giving 1.5%, not 2.0%.

    Reported 2 · recomputed 1.492537

  • Zero UK maternal deaths are labelled 100%

    Minor

    Table 4 reports zero UK maternal deaths but gives their percentage as 100%; zero out of 134 is 0%.

    Reported 100 · recomputed 0

4 of 4

The citation lists haven’t been fetched yet

References 41 · Cited by 38

Research works printed but not linked: 1

  1. Royal College of Obstetricians and Gynaecologists, 2011, Green–top guideline no. 27. Placenta Praevia, placenta Praevia Accreta and vasa Praevia: Diagnosis and management

Authors
McCall, S. J., Deneux‐Tharaux, C., Sentilhes, L., Ramakrishnan, R., Collins, S. L., Seco, A., Kurinczuk, J. J., Knight, M., & Kayem, G.
Affiliations
  • Inserm (FR)
  • Department of Obstetrics and Gynecology Bordeaux University Hospital Bordeaux France
  • University of Oxford (GB)
  • John Radcliffe Hospital (GB)
  • Université Paris Descartes (FR)
Corresponding author
Kayem, Gilles
ORCID
Venue
BJOG: An International Journal of Obstetrics & Gynaecology
Publisher
Wiley
Published
2022-04-29
Volume
129
Issue
10
Pages
1676-1685
ISSN
  • 0306-5456 (ISSN-L)
  • 1470-0328
  • 1471-0528
DOI
10.1111/1471-0528.17169
PMC
PMC9544707
OpenAlex
W4225248472
Semantic Scholar
194c1ab3d0a9f583e05b560137bc41b79250c603
Cited by
38
References
41
Citations by year
2026: 6 · 2025: 6 · 2024: 18 · 2023: 6 · 2022: 2
FWCI
9.32
Type
journal article
Language
en
Open access
Licence
Locations
  • BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
Funders
University of Kentucky
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Keywords
placenta accreta spectrum, cesarean hysterectomy, postpartum hemorrhage, maternal morbidity, blood loss, postpartum infection, cross-national comparison, obstetric management
MeSH terms
Cesarean Section, Female, United Kingdom, Postpartum Hemorrhage, Humans, Hysterectomy, Placenta Accreta, Pregnancy, Retrospective Studies

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