Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia

Abstract Background In low middle income countries (LMICs), the increase in the rate of caesarean surgery, a main risk of placenta accreta spectrum (PAS), and limited resources to manage it. In Indonesia a PAS clinical guideline was developed, and disseminated, a regional PAS Centre was set up within a functional comprehensive emergency obstetric care (CEmOC) and the quality of care provided afterwards evaluated. Study Design: A retrospective cohort study design that included all suspected PAS cases referred in between January 2020 to December 2022, in Semarang, Indonesia. The study compared the quality of care provided for invasive and non-invasive cases. Differences in quality of care in each outcome group was explored at different shifts and periods of the day, public holidays or weekends and weekdays. The quality of 24/7 care based on maternal outcome, timeliness of emergency care, and adherence to national PAS management guidelines was evaluated. Results Ninety-nine of the 154 (64.28%) referral patients with suspected PAS were in the invasion group. Of these, 81 (81.8%) were diagnosed prenatally and confirmed at surgery or histopathology. The quality of care was similar between women with and without invasion regardless of time intervention. The multidisciplinary team and blood unit availability were found to be the key performance of adherence to the standard process.. The decision to delivery interval (DDI) of ≤ 30 minutes was the most important missing element in the timeliness of emergency care, with median (IQR) 57.50 (30–120) minutes on weekdays and 43.00 (20–66) minutes on public holidays and weekends in the invasion group. Nevertheless, in emergency cases, the access to ICU and time to transfusion in invasion group was adequate. A reduction in case fatality rate (CFR) of PAS was observed from 4.0% (2020) to 3.03% (2022). Conclusions The findings suggest that the regional PAS centre is functioning optimally according to national PAS guidelines, with no difference in the quality of care provided to all referred suspected PAS cases irrespective of the degree of placental invasion, the time of the day or period of the week.