Placenta Accreta Spectrum: Risk Factors for Unplanned Immediate Hysterectomy in Planned Uterine Preservation Surgery

Abstract

Objective

Placenta accreta spectrum (PAS) is a term used to describe trophoblast invasion into the uterine wall. The condition can be fatal at labor due to a lack of spontaneous separation of the placenta from the uterine wall, leading to severe hemorrhage. In this study, we aim to evaluate preoperative risk factors for unplanned immediate hysterectomy in PAS uterine-preserving surgeries.

Study Design

Preoperative parameters of women who underwent successful uterine-preserving surgery were retrospectively compared with those who underwent an unplanned immediate hysterectomy during these surgeries. A multivariable regression analysis was conducted to identify independent factors associated with unplanned immediate hysterectomy.

Results

Overall, 238 were included in the study's cohort. A total of 86.2% underwent successful uterine-preserving surgery, and 13.8% underwent an unplanned immediate hysterectomy. The number of previous cesarean deliveries (CDs) and the proportion of women with grade 3 preoperative PAS was significantly lower among the successful uterine-preserving group. The proportion of preoperative ultrasound lacunae detection, the number of lacunae observed, loss of clear zone detection, the length of clear zone loss, the proportion of retroplacental hypervascularity, bridging vessels detection, and bladder involvement were significantly lower in the successful uterine-preserving group. In a multivariable regression analysis, the presence of lacunae and loss of clear zone were independently associated with unplanned cesarean hysterectomy (adjusted odds ratio [aOR] = 3.18 [95% confidence interval (CI): 1.11–11.6], p = 0.047, and aOR = 3.67 [95% CI: 1.3–13.2], p = 0.025, respectively].

Conclusion

Preoperative assessment of the applicability of a uterine-preserving surgery may be performed using the ultrasound parameters reported in this study.

Key Points

• Applicability of a uterine-preserving surgery may be performed using sonographic parameters.

• Sonographic presence of lacunae is associated with an unplanned hysterectomy.

• Sonographic loss of clear zone is associated with an unplanned hysterectomy.

Keywords

placenta accreta spectrum - uterine-preserving surgery - hysterectomy - conservative management - sonographic characteristics

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval was waived by the local Ethics Committee of University A in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The study protocol was approved by the Chaim Sheba Medical Center ethical committee (7145-20-SMC, 30/09/2020), which waived the need for informed consent.

Authors' Contributions

L.F., G.L., and R.M. contributed to the conception and design of the work. L.F. and N.M. collected the data. L.F., A.W-B., E.K., T.W., E.C., G.L., and R.M. contributed to the acquisition and interpretation of the data. L.F., S.N.F., and R.M. wrote the paper. All authors revised and approved the final manuscript.

Publication History

Received: 22 June 2024

Accepted: 25 November 2024

Accepted Manuscript online:
26 November 2024

Article published online:
24 December 2024

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