(805) Maternal Fetal Medicine Fellow Experience with Placenta Accreta Spectrum Care

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Kristen L. Moriarty, MD

UCONN Health
Farmington, Connecticut, United States

Coauthor(s)

Andrea D. Shields, MD, MS (she/her/hers)

Program Director, Maternal Fetal Medicine Fellowship
University of Connecticut Health
Avon, Connecticut, United States
Nicole R. Gavin, MD

Assistant Professor
University of Connecticut
Farmington, Connecticut, United States

Objective: Evaluate MFM fellows' experience with PAS management and their desire to perform PAS surgeries post-fellowship.

Study Design: A 43 question IRB approved survey regarding PAS exposure was validated with experts and novice learners. The survey was distributed via REDCap™ to fellowship program directors for dissemination from June-July 2024. Baseline demographics: fellowship year, region, number of fellows in the program, and if home program was a PAS center of excellence. Primary outcome: fellows' desire to participate in PAS post-fellowship. Secondary outcomes: various aspects of PAS participation. Chi square and pearson’s t-test analyzed outcome variables.

Results: 42 MFM fellows responded, distributed evenly by year (PGY5-7+: 33.3%, 28.6%, 38.1%) and region (Northeast 38.1%, South 31%, Midwest 19%, West 11.9%). Most programs (52.4%) had 5+ fellows, and 64.3% identified as PAS center. Prior to fellowship, 90.5% of fellows participated in some aspect of PAS care, with 52% performing 1-5 cases. 60% of fellows previously in OBGYN practice had performed PAS cases as primary surgeons. 64.3% of fellows reported training in a PAS program influenced their fellowship ranking. During fellowship, all respondents participated in ultrasound and intrapartum PAS management, with 95.2% involved in surgical management. Over one-third (35.7%) performed 1-5 PAS cases during fellowship and there was no difference in the number of hysterectomies performed per fellowship year (p=0.916). Two-thirds (66.7%) expressed a desire to perform PAS cases post-training and those who desired felt more confident managing the entire surgery for PAS (p=< 0.001) as well as managing the routine post-operative care (p=0.025) and showed a trend toward training at a PAS center of excellence (p=0.08).

Conclusion: 2/3 of fellows intend to perform PAS cases post-training and felt confident managing the entire surgery for PAS patients and had a trend to have trained a PAS center of excellence. A solid foundation in PAS identification, management, and care coordination during training is essential for fellows' future participation in PAS care.