Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta.

OBJECTIVE: We surveyed obstetricians to determine their knowledge, patterns of care and treatment preferences for women with placenta accreta. METHODS: A 27-item survey was mailed to fellows of the American College of Obstetricians and Gynecologists. The survey included demographics, questions regarding knowledge and items to examine practice patterns. RESULTS: Among 994 surveyed practitioners 508 responded including 338 who practiced obstetrics. Among generalists, 23.8% of respondents referred patients with placenta accreta to a sub-specialist. Overall, 20.4% referred women to the nearest tertiary center, and 7.1% referred to a regional center. Delivery was recommended at 34-36 weeks by 41.2%. Adjuvant interventions including ureteral stents (26.3%), iliac artery embolization catheters (28.1%), and balloon occlusion catheters (20.1%) were used infrequently. Six or more units of blood were crossed for delivery by only 29.0% of practitioners. CONCLUSION: There is widespread variation in the care of women with or at risk for placenta accreta.