Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study

Background: Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy. Objective: This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS. Materials and Methods: In this retrospective cross-sectional study, the records of ۶۸ women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March ۲۰۱۵ and February ۲۰۲۰ were included. The women divided into ۲ groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization was compared between groups. Results: In total, we investigated ۶۸ women between the ages of ۲۴-۴۵ yr (mean age of ۳۲.۸۸ ± ۵.۰۸ yr). All participants were multiparous and underwent cesarean section. Furthermore, ۲۸ women (۴۱.۲%) had a history of curettage. In total, ۲۴ women (۳۵.۳%) underwent hysterectomy, and ۴۴ (۶۴.۷%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization. Conclusion: The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Keywords:

Placenta accreta , Placenta diseases , Pregnancy complications , Conservative treatment , Hysterectomy. , چسپندگی جفت , بیماری­ های جفت , عوارض بارداری , درمان حفظ کننده , هیسترکتومی.