Abstract
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 was more likely to
be TAH. TAH was 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 the management of PAS should be further explored.
Key Points
-
In PAS, outcomes are at least equivalent between TAH and SCH.
-
C-HYST is optimally performed in a planned manner with all multidisciplinary team
members present.
-
Vertical skin incision was significantly associated with TAH in this retrospective
cohort study.
Keywords
placenta accreta spectrum - cesarean hysterectomy - total abdominal hysterectomy -
supracervical hysterectomy
