Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study

Aviran Ohayon; Elias Castel; Lior Friedrich; Nitzan Mor; Gabriel Levin; Raanan Meyer; Shlomi Toussia-Cohen

doi:10.1055/s-0044-1787543

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(01): 068-074
DOI: 10.1055/s-0044-1787543

Original Article

Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study

Aviran Ohayon

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

,

Elias Castel

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

,

Lior Friedrich

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

³Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

,

Nitzan Mor

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

,

Gabriel Levin

⁴Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel

,

Raanan Meyer

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

,

Shlomi Toussia-Cohen

¹Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

› Author Affiliations

Abstract

Objective This study aimed to investigate maternal and neonatal outcomes in subsequent pregnancies of women with a history of placenta accreta spectrum (PAS) compared with women without history of PAS.

Study Design A retrospective cohort study conducted at a single tertiary center between March 2011 and January 2022. We compared women with a history of PAS who had uterine preservation surgery and a subsequent pregnancy, to a control group matched in a 1:5 ratio. The primary outcome was the occurrence of a composite adverse outcome (CAO) including any of the following: uterine dehiscence, uterine rupture, blood transfusion, hysterectomy, neonatal intensive care unit admission, and neonatal mechanical ventilation. Multivariable logistic regression was performed to evaluate associations with the CAO.

Results During the study period, 287 (1.1%) women were diagnosed with PAS and delivered after 25 weeks of gestation. Of these, 32 (11.1%) women had a subsequent pregnancy that reached viability. These 32 women were matched to 139 controls. There were no significant differences in the baseline characteristics between the study and control groups. Compared with controls, the proportion of CAO was significantly higher in women with previous PAS pregnancy (40.6 vs. 19.4%, p = 0.019). In a multivariable logistic regression analysis, previous PAS (adjusted odds ratio [aOR] = 3.31, 95% confidence interval [CI] = 1.09–10.02, p = 0.034) and earlier gestational age at delivery (aOR = 3.53, 95% CI = 2.27–5.49, p < 0.001) were independently associated with CAOs.

Conclusion A history of PAS in a previous pregnancy is associated with increased risk of CAOs in subsequent pregnancies.

Key Points

The uterine-preserving approach for PAS delivery is gaining more attention and popularity in recent years.
Women with a previous pregnancy with PAS had higher rates of CAOs in subsequent pregnancies.
Previous PAS pregnancy is an independent factor associated with adverse outcomes.

Keywords

cesarean delivery - composite adverse outcome - maternal outcomes - neonatal outcomes - obstetric outcomes - placenta accreta spectrum

Full Text

References

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