Outcomes of total abdominal hysterectomy compared to supracervical hysterectomy for management of placenta accreta spectrum

Objective: Although cesarean hysterectomy (C-HYST) is standard management for placenta accreta spectrum (PAS), the type of hysterectomy performed, total abdominal (TAH) or supracervical (SCH), is left to surgeon discretion. TAH has been previously associated with higher estimated blood loss (EBL), transfusion requirements, and complications compared to SCH. Study Design: This was a single-site retrospective cohort study examining outcomes of TAH compared to SCH for PAS performed from 2008 to 2023. PAS was confirmed by clinical and pathologic diagnoses. Cervical removal was confirmed by operative report, postoperative exam, and pathology. Associations were assessed using chi-square tests, Fisher’s exact tests, Mann-Whitney U tests, or individual t-tests. Results: During the study period, 90 TAH and 54 SCH were performed. There were no significant differences in patient demographics, except that planned C-HYST were more likely to be TAH. TAH were associated with significantly lower transfusion requirements. When unexpected hysterectomies were excluded, there was not a significant difference in blood products transfused between the TAH and SCH groups. Conclusion: In PAS, maternal outcomes after TAH are at least equivalent to SCH. The surgical approach for management of PAS should be further explored.

Publication History

Received: 28 March 2025

Accepted after revision: 18 May 2025

Accepted Manuscript online:
19 May 2025