Outcomes of cesarean delivery in placenta accreta: conservative delivery vs. cesarean hysterectomy

Weissmann-Brenner Alina; Castel Elias; Kassif Eran; Friedrich Lior; Mor Nizan; Levin Gabriel; Lahav Ezra Hila; Meyer Raanan

doi:10.1515/jpm-2023-0154

Article

Outcomes of cesarean delivery in placenta accreta: conservative delivery vs. cesarean hysterectomy

Weissmann-Brenner Alina , Castel Elias , Kassif Eran , Friedrich Lior , Mor Nizan , Levin Gabriel , Lahav Ezra Hila and Meyer Raanan

Published/Copyright: August 21, 2023

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From the journal Journal of Perinatal Medicine Volume 52 Issue 1

Abstract

Objectives

To compare delivery outcomes of pregnancies diagnosed with placenta-accreta-syndrome (PAS) who underwent conservative treatment to patients who underwent cesarean hysterectomy.

Methods

A retrospective study of all women diagnosed with PAS treated in one tertiary medical center between 03/2011 and 11/2020 was performed. Comparison was made between conservative management during cesarean delivery and cesarean hysterectomy. Conservative management included leaving uterus in situ with/without placenta and with/without myometrial resection.

Results

A total of 249 pregnancies (0.25 % of all deliveries) were diagnosed with PAS, 208 underwent conservative cesarean delivery and 41 had cesarean hysterectomy, 31 of them were unplanned (75.6 %). The median number of previous cesarean deliveries was significantly higher in the cesarean hysterectomy group. There was no difference in the duration from the last cesarean delivery, the presence of placenta previa, pre-operative hemoglobin or platelets levels between the pregnancies with conservative management and the cesarean hysterectomy. Significantly more pregnancies with sonographic suspicion of placenta percreta and bladder invasion had cesarean hysterectomy. Cesarean hysterectomy was significantly associated with earlier delivery, with bleeding and required significantly more blood products. There was no statistically significant difference in the rate of relaparotomy following cesarean delivery or the rate of infections. Multivariable-regression-analysis revealed a significant odds ratio of 3.38 of blood loss of >3,000 mL following cesarean hysterectomy.

Conclusions

Conservative management in delivery of PAS pregnancies is associated with less bleeding complications during surgery compared to cesarean hysterectomy.

Keywords: bleeding; cesarean hysterectomy; conservative management; placenta accreta

Corresponding author: Weissmann-Brenner Alina, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel; and The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel, Phone: +972 3 5308116, Fax: +972 3 5303168, E-mail: alinabrenner@yahoo.com

Prof. Weissmann-Brenner Alina and Dr. Castel Elias contributed equally to this work.

Research ethics: Approval for the study was granted by the Institutional Review Board of the Chaim Sheba Medical Center, no. 7223-20-SMC.
Informed consent: Due to the retrospective nature of the study we received approval from the IRB committee not to receive informed consent from the patients.
Author contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Prof. Weissmann-Brenner Alina, Dr. Castel Elias, Dr. Kassif Eran, Dr. Friedrich Lior, Dr. Mor Nizan, Dr. Levin Gabriel, Dr. Lahav Ezra Hila and Dr. Meyer Raanan. The first draft of the manuscript was written by Prof. Weissmann-Brenner Alina and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

1. Silver, RM, Branch, DW. Placenta accreta spectrum. N Engl J Med 2018;378:1529–36. https://doi.org/10.1097/01.aoa.0000547281.17412.12.Search in Google Scholar

2. Timor-Tritsch, IE, Monteagudo, A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012;207:14–29. https://doi.org/10.1016/j.ajog.2012.03.007.Search in Google Scholar PubMed

3. Kayem, G, Seco, A, Beucher, G, Dupont, C, Branger, B, Crenn Hebert, C, et al.. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021;128:1646–55. https://doi.org/10.1111/1471-0528.16647.Search in Google Scholar PubMed

4. Kingdom, JC, Hobson, SR, Murji, A, Allen, L, Windrim, RC, Lockhart, E, et al.. Minimizing surgical blood loss at esarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020. Am J Obstet Gynecol 2020;223:322–9. https://doi.org/10.1016/j.ajog.2020.01.044.Search in Google Scholar PubMed PubMed Central

5. Amsalem, H, Kingdom, JCP, Farine, D, Allen, L, Yinon, Y, D’Souza, DL, et al.. Planned caesarean hysterectomy versus “conserving”caesarean section in patients with placenta accreta. J Obstet Gynaecol Can 2011;33:1005–10. https://doi.org/10.1016/s1701-2163(16)35049-6.Search in Google Scholar PubMed

6. Shazly, SA, Hortu, I, Shih, JC, Melekoglu, R, Fan, S, Ahmed, FUA, et al.. Prediction of success of uterus-preserving management in women with placenta accreta spectrum (CON-PAS score): a multicenter international study. Int J Gynaecol Obstet 2021;154:304–11. https://doi.org/10.1002/ijgo.13518.Search in Google Scholar PubMed

7. D’Antonio, F, Palacios-Jaraquemada, J, Lim, PS, Forlani, F, Lanzone, A, Timor-Tritsch, I, et al.. Counseling in fetal medicine: evidence-based answers to clinical questions on morbidly adherent placenta. Ultrasound Obstet Gynecol 2016;47:290–301. https://doi.org/10.1002/uog.14950.Search in Google Scholar PubMed

8. Jauniaux, E, Hussein, AM, Fox, KA, Collins, SL. New evidence-based diagnostic and management strategies for placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol 2019;61:75–88. https://doi.org/10.1016/j.bpobgyn.2019.04.006.Search in Google Scholar PubMed PubMed Central

9. Clausen, C, Lönn, L, Langhoff-Roos, J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 2014;93:138–43. https://doi.org/10.1111/aogs.12295.Search in Google Scholar PubMed

10. Sentilhes, L, Kayem, G, Descamps, P, Bretelle, F, Goffinet, F. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010;115:526–34. https://doi.org/10.1097/aog.0b013e3181f738d8.Search in Google Scholar

11. Kutuk, MS, Ak, M, Ozgun, MT. Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2018;140:338–44. https://doi.org/10.1002/ijgo.12308.Search in Google Scholar PubMed

12. Lional, KM, Tagore, S, Wright, AM. Uterine conservation in placenta accrete spectrum (PAS) disorders: a retrospective case series: is expectant management beneficial in reducing maternal morbidity? Eur J Obstet Gynecol Reprod Biol 2020;254:212–7. https://doi.org/10.1016/j.ejogrb.2020.09.029.Search in Google Scholar PubMed

13. Giammarco, S, Sica, S, Chiusolo, P, Laurenti, L, Sorá, F, Martino, M, et al.. Eltrombopag for the treatment of poor graft function following allogeneic stem cell transplant: a retrospective multicenter study. Int J Hematol 2021;114:228–34. https://doi.org/10.1007/s12185-021-03153-3.Search in Google Scholar PubMed

14. Sivan, E, Spira, M, Achiron, R, Rimon, U, Golan, G, Mazaki-Tovi, S, et al.. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy? Am J Perinatol 2010;27:455–61. https://doi.org/10.1055/s-0030-1247599.Search in Google Scholar PubMed

15. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Obstetric care consensus no. 7 summary: placenta accrete spectrum. Obstet Gynecol 2018;132:159–21.10.1097/AOG.0000000000002984Search in Google Scholar PubMed

16. D’Souza, DL, Kingdom, JC, Amsalem, H, Beecroft, JR, Windrim, RC, Kachura, JR. Conservative management of invasive placenta using combined prophylactic internal iliac artery balloon occlusion and immediate postoperative uterine artery embolization. Can Assoc Radiol J 2015;66:179–84. https://doi.org/10.1016/j.carj.2014.08.002.Search in Google Scholar PubMed

17. Cali, G, Labate, F, Cucinella, G, Fabio, M, Buca, D, Di Girolamo, R, et al.. Placenta accreta spectrum disorders in twin pregnancies as an under reported clinical entity: a case series and systematic review. J Matern Fetal Neonatal Med 2022;13:1–4. https://doi.org/10.1080/14767058.2021.2005568.Search in Google Scholar PubMed

18. Sentilhes, L, Seco, A, Azria, E, Beucher, G, Bonnet, MP, Branger, B, et al.. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study. Am J Obstet Gynecol 2021;14:S0002-9378:2655–7.Search in Google Scholar

19. Flores-Mendoza, H, Chandran, AR, Hernandez-Nieto, C, Murji, A, Allen, L, Windrim, RC, et al.. Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean-hysterectomy within a multidisciplinary care team. Int J Gynaecol Obstet 2022;159:404–11. https://doi.org/10.1002/ijgo.14121.Search in Google Scholar PubMed

20. Cavalli, C, Maggi, C, Gambarini, S, Fichera, A, Santoro, A, Grazioli, L, et al.. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders. J Perinat Med 2021;50:277–85. https://doi.org/10.1515/jpm-2021-0334.Search in Google Scholar PubMed

Received: 2023-04-13

Accepted: 2023-08-05

Published Online: 2023-08-21

Published in Print: 2024-01-29

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0154

Keywords for this article

bleeding; cesarean hysterectomy; conservative management; placenta accreta