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 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 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 were compared between groups.
Results: In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 ± 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine
preservative surgeries in terms of the 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.
Key words: Placenta accreta, Placenta diseases, Pregnancy complications,
Conservative treatment, Hysterectomy.
 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.
 Conturie CL, Lyell DJ. Prenatal diagnosis of placenta accreta spectrum. Curr Opin Obstet Gynecol 2022; 34: 90–99.
 Cnota W, Banas E, Dziechcinska-Poletek D, Janowska E, Jagielska A, Piela B, et al. “The Killer Placenta”-a threat to the lives of young women giving birth by cesarean section. Ginekol Pol 2022; 93: 314–320.
 Eren EC, Basım P. Role of peripheral inflammatory biomarkers, transforming growth factor-beta and interleukin 6 in predicting peritoneal adhesions following repeat cesarean delivery. Ir J Med Sci 2022: 1–8. (in Press)
 Matsuzaki S, Ueda Y, Nagase Y, Matsuzaki S, Kakuda M, Kakuda S, et al. Placenta accreta spectrum disorder complicated with endometriosis: Systematic review and meta-analysis. Biomedicines 2022; 10: 390.
 Jolley JA, Nageotte MP, Wing DA, Shrivastava VK. Management of placenta accreta: A survey of maternalfetal medicine practitioners. J Maternal Fetal neonatal Med 2012; 25: 756–760.
 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine Collaborators. Obstetric care consensus no. 7: Placenta accreta spectrum. Obstet Gynecol 2018; 132: e259–e275.
 Aryananda RA, Aditiawarman A, Gumilar KE, Wardhana MP, Akbar MIA, Cininta N, et al. Uterine conservativeresective surgery for selected placenta accreta spectrum cases: Surgical-vascular control methods. Acta Obstet Gynecol Scand 2022; 101: 639–648.
 Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, et al. Conservative management of morbidly adherent placenta: Expert review. Am J Obstet Gynecol 2015; 213: 755–760.
 Meyer NP, Ward GH, Chandraharan E. Conservative approach to the management of morbidly adherent placentae. Ceylon Med J 2012; 57: 36–39.
 Sentilhes L, Goffinet F, Kayem G. Management of placenta accreta. Acta Obstet Gynecol Scand 2013; 92: 1125–1134.
 Reale SC, Farber MK. Management of patients with suspected placenta accreta spectrum. BJA Educ 2022; 22: 43–51.
 Li N, Yang T, Liu C, Qiao C. Feasibility of infrarenal abdominal aorta balloon occlusion in pernicious placenta previa coexisting with placenta accrete. Biomed Res Int 2018; 2018: 4596189.
 Kollmann M, Gaulhofer J, Lang U, Klaritsch P. Placenta praevia: Incidence, risk factors and outcome. J Matern Fetal Neonatal Med 2016; 29: 1395–1398.
 Sheiner E, Levy A, Katz M, Mazor M. Identifying risk factors for peripartum cesarean hysterectomy: A populationbased study. J Reprod Med 2003; 48: 622–626.
 Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL, et al. Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. J Matern Fetal Neonatal Med 2013; 26: 1602– 1609.
 Cal M, Ayres-de-Campos D, Jauniaux E. International survey of practices used in the diagnosis and management of placenta accreta spectrum disorders. Int J Gynecol Obstet 2018; 140: 307–311.
 Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: A systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217: 27–36.
 Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: A systematic review of prenatal ultrasound
imaging and grading of villous invasiveness. Am J Obstet Gynecol 2016; 215: 712–721.
 Amsalem H, Kingdom JC, 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: 1005–1010.
 Gatta LA, Lockhart EL, James AH. Blood products in the management of abnormal placentation. Clin Obstet Gynecol 2018; 61: 828–840.
 Wodajo S, Belayneh M, Gebremedhin S. Magnitude and factors associated with post-cesarean surgical site infection at Hawassa University teaching and referral hospital, southern Ethiopia: A cross-sectional study. Ethiop J Health Sci 2017; 27: 283–290.
 Durukan H, Durukan ÖB, Yazıcı FG. Placenta accreta spectrum disorder: A comparison between fertility-sparing techniques and hysterectomy. J Obstet Gynaecol 2021; 41: 353–359.
 Sentilhes L, Kayem G, Mattuizzi A. Conservative approach: Intentional retention of the placenta. Best Pract Res Clin Obstet Gynaecol 2021; 72: 52–66.
 Palacios-Jaraquemada JM, Fiorillo A, Hamer J, Martínez M, Bruno C. Placenta accreta spectrum: A hysterectomy can be prevented in almost 80% of cases using a resectivereconstructive technique. J Matern Fetal Neonatal Med 2022; 35: 275–282.
 Sentilhes L, Kayem G, Silver RM. Conservative management of placenta accreta spectrum. Clin Obstet Gynecol 2018; 61: 783–794.