(228) Utility of standardized FIGO descriptors for reporting of intra-operative findings of placenta accreta spectrum disorders.

Proper reporting of placenta accreta spectrum disorder (PASD) findings intra-operatively allows consistency of communications between multidisciplinary teams within the institution and improves research opportunities on national and international levels.  The universal use of the International Federation of Gynecology and Obstetrics (FIGO) classification for a description of intra-operative findings is an important tool for potential use in this standardization.

Study Design:

We conducted a retrospective chart review of patients delivered for PASD at the University Health System in San Antonio, TX in twelve-month period between 2022 and 2023. We compared the reported rate of intra-operative findings and reported standardized FIGO descriptors before and after the implementation of standardized use of the FIGO criteria.

Results:

A total of 30 cases were evaluated: 17 pre-implementation and 13 post-implementations. Pre-implementation, cesarean hysterectomy was performed in 13 out of 17 cases (76.5%) with histological confirmation of placenta percreta in 69.2%, increta in 15.4%, and accreta in 15.4%. Post-implementation, cesarean hysterectomy was performed in 10 out of 13 (76.9%) cases with histological confirmation of placenta percreta in all cases (100%). Intraoperative findings were documented in all (100%) charts.  FIGO staging classification was not used in the pre-implementation period and was utilized in 69.2% of cases after the implementation. The reporting of “bluish/purple coloring, distention or bulge” increased from 41.2% to 84.6%, “hypervascularity” description improved from 52.9% to 76.9%, “placenta tissues in the uterus or clear plane between the uterus and bladder” improved from 41.2% to 84.6%, “invasion into the bladder or nearest organs” improved from 41.2% to 69.2% in 2022 and 2023 respectively. Table 1 demonstrated a reported rate of standardized intra-operative descriptors.

Conclusion: The use of a standardized FIGO classification approach for reporting intra-operative findings during PASD cases in our institution significantly improved the quality of reported findings.