Choosing A Hospital

 
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Written by Alexis Carena, November 2019

Where An Accreta Patient deliver matters

When it comes to a life-threatening, high-risk pregnancy condition like placenta accreta spectrum the quality of care received matters greatly. It requires specialized maternity and neonatal care including expertise, equipment, and protocols. Furthermore, evidence suggests that patient and child outcomes are better at hospitals that have established accreta teams and do volume of these deliveries. But not all hospitals are alike and offer this specialized care for accreta. Therefore when diagnosed with placenta accreta, choosing a hospital and ensuring the best care can be one of the most important decisions a mom and her family makes.

Since there isn’t an accreditation, designation or consumer reports for an accreta hospital this can make the search for them difficult. It can seem unwieldy and stressful to find the right hospital and experts. However, there are some criteria for accreta moms to consider as they search for specialists and a hospital that will be in charge of delivering their baby and ensure the best outcome for mom and child. As you’re talking to your provider, talk to them about the criteria below and ask them lots of questions about these topics. You may consider getting a second or even a third opinion from another provider or referral center. This is a reasonable request and should be met with open arms. You are the biggest stakeholder in your life and your child’s birth and it’s crucial that you feel comfortable with your choices.

 
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Efforts to Improve maternal care

In 2015, ACOG and the Society for Maternal-Fetal Medicine announced a standardized risk-appropriate maternal care system for hospitals to reduce overall maternal morbidity and mortality in the United States. This designation proposed four levels of maternal care centers. ACOG recommends “women with suspected placenta accreta spectrum diagnosed in the antenatal period based on imaging or clinical acumen should be delivered at a level III or IV center with considerable experience whenever possible to improve outcomes.” Several states have taken steps to adopt the new level of care designations but it’s still early days. Eventually, the maternal level of care requirements will make a major impact on maternal safety and make it easier for accreta patients to choose a hospital.

The same year, several accreta experts published an article defining criteria for an accreta center of excellence. They highlighted the importance of having an experienced and coordinated village of experts to manage accreta cases.

Both efforts have helped pave the way for improvements in caring for accreta moms but there is still a lack of resources available. Finding these hospitals and providers is not an easy task for a patient and referring providers, leaving many patients unsure of their current care and the road ahead.

Key Criteria to consider

Based on the sources above, here is criteria to consider when evaluating a hospital along with sample questions to ask your provider.

  • Placenta Accreta Expertise: Doctors with experience in the care of placenta accreta and appropriate surgical expertise is critical. Some hospitals have developed specific placental disorder programs and teams to help manage the increased number of patients.

    • Ask your provider: How many accreta cases have you and the hospital managed over the past year? Does your facility have a program and protocols specifically for placenta accreta spectrum? Is the team led by a board-certified maternal-fetal medicine (MFM) or obstetrician-gynecologist with expertise in critical care obstetrics? Is the MFM team available at all times for on-site consultation and management?

  • Multidisciplinary Team: Accreta moms have an increased risk for hemorrhage and surgical complications and an accreta surgery can be best managed by specialists and multidisciplinary team. Since one doesn’t know what will be encountered during surgery it’s absolutely best to be prepared and have this team available in case they are needed. Trauma 1 hospitals are more likely to have these multidisciplinary experts available and on call 24-hours. Check here to see where the closest trauma 1 hospital is to you. 

    • Ask your provider: Does the hospital have experts on hand that focus on maternal-fetal medicine and gynecologic surgery and experts experienced in massive hemorrhage (see table 1 for a full list)? Do you plan to have this team available for my surgery? Does the hospital have a board-certified anesthesiologist with training or experience in obstetric anesthesia and available at all times onsite? Does the hospital have continuous availability of nurses who have experience in the care of women with complex obstetric complications?

  • Blood Bank: Accreta moms are at risk for massive hemorrhage and there’s a high chance (up to 90%) that a blood transfusion will be required, often in large quantities.

    • Ask your provider: Does the hospital have an accessible well-stocked blood bank? Does the facility have a well-established massive transfusion protocol in case I hemorrhage during surgery?

  • Intensive Care Unit (ICU): There is the potential need for accreta moms to require admission to an intensive care unit after surgery so it’s essential that the hospital is equipped to ensure they are ready in case critical care is needed.

    • Ask your provider: Does the hospital have 24-hour availability of on-site intensive care specialists for obstetric patients? What level ICU is the hospital (level 3 is the highest)?

  • Neonatal Intensive Care Unit (NICU): As a result of preterm delivery, many accreta babies require admission to a neonatal care intensive care unit. Look for a hospital that has access to a level III or IV NICU for lifesaving interventions, should your baby need it. This is also important so that the patient and baby are not separated and end up in different hospitals when the baby needs a level of care that isn't represented at birth facility (and vice versa). 

    • Ask your provider: What level NICU is the hospital (IV is highest)? If my baby needs NICU care and I need ICU care, will we both receive care in the same facility?

 
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OTHER CONSIDERATIONS

Distance and Housing: Some moms make the decision to travel quite far from their homes to deliver in the best hospital equipped for their case. This can be very difficult emotionally, logistically and financially. Be sure to ask the doctor or hospital’s social worker about services to make it easier. Some hospitals have a Ronald McDonald house or offsite apartments for families that need to travel far. This is especially useful if the mom is hospitalized for some time prior to delivery and is discharged before the baby leaves the NICU.

Referrals and Support: Ask in the accreta patient support groups about referral centers, hospitals and doctors in your area. In several countries and U.S. states/metro areas there are local support groups with knowledge about local hospitals and providers. This can sometimes be the most up to date resource as doctors change and hospitals improve their expertise managing placenta accreta.

Follow Your Gut: After doing your research and gathering opinions from a provider or two, or more, listen to your intuition. If you’re not feeling right about your care, keep looking. Find a provider you feel comfortable with, who will support you and ensure you get the very best care. Once again, this is YOUR decision and YOU are empowered to choose.

 
 

List of Hospitals and Providers

National Accreta Foundation does not endorse any hospitals or providers and therefore does not provide a list. Please see our medical disclaimer for more information.


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Alexis Carena experienced placenta accreta, which required life-saving surgery and blood transfusions, during her son’s birth. She has shared her patient story at her hospital, blood drives, and beyond. Alexis started a local accreta support group in the Washington D.C., Maryland and Virginia areas to help moms find local accreta providers, resources and support.

 

Content on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional, please see our medical disclaimer here.