190: UC Fetal Consortium (UCfC) multidisciplinary team approach to invasive placenta: Management across a five institution consortium

The five-institution UCfC has a multidisciplinary team approach to invasive placenta. Compilation of data across this consortium will facilitate identification of best practices. Retrospective chart review of all cases of pathologically confirmed invasive placenta delivered from 2009 to 2014 at UCfC centers. Differences in intraoperative management based on prenatal imaging and related outcomes compared among prenatally diagnosed cases. Interventions assessed: ureteral stent use, iliac balloon use, anesthetic type, gynecologic oncology involvement, and cell saver use. Interventions varied by site. Analyses adjusted for final pathologic diagnosis. Chi-square, Fisher’s exact, student’s-t test, and Mann-Whitney U test used as appropriate. Binary logistic regression and multivariable linear regression used to adjust for confounders. One hundred and fifty-one cases of pathologically confirmed invasive placenta were identified, and 82% (123) were diagnosed prenatally. There was no correlation between the degree of invasion on prenatal imaging and use of each intervention. Ureteral stents were placed in 33% (41) and did not reduce GU injury. Iliac balloons were placed in 29% (36) and correlated with shorter OR time (161 vs 236 min, p<0.01) and lower estimated blood loss (EBL) (1800 vs 2500 ml, p<0.01). General endotracheal anesthesia (GETA) was used in 70% (86). EBL did not differ between GETA and regional anesthesia. Gyn Oncology was involved in 46% (45), and involvement was more likely for obese patients (76% vs 42%, p<0.01) and those with a higher number of prior cesarean deliveries (p<0.01). There was no difference in EBL, operating time, or intraoperative complications. Cell saver was used in 20% (24) and was associated with longer OR time (296 vs 200 min, p<0.01). Use of cell saver was associated with increased EBL in unadjusted analysis; there was no difference in EBL adjusted for final pathology. Cell saver use did not reduce units of packed red cells transfused. All analyses adjusted for severity of invasion (Table). Specific operative practices did not affect outcomes in invasive placenta, with exception of balloon placement. Gyn Oncology more likely to be involved in complex cases. A team of experienced operators with a standard approach may be more significant than specific practices.