Abstract
Objective To investigate the association between the intraoperative diagnosis of placenta accreta
at the time of cesarean hysterectomy and pathological diagnosis.
Study Design This is a retrospective cohort study of all patients undergoing cesarean hysterectomy
for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary
outcome was the presence of invasive placentation on the pathology report. We estimated
predictive characteristics of clinical diagnosis of placenta accreta using pathological
diagnosis as the correct diagnosis.
Results There were 50 cesarean hysterectomies performed for suspected abnormal placentation
from 2000 to 2016. Of these, 34 (68%) had a diagnosis of accreta preoperatively and
16 (32%) were diagnosed intraoperatively at the time of cesarean delivery. Two patients
had no pathological evidence of invasion, corresponding to a false-positive rate of
4% (95% confidence interval [CI]: 0.5%, 13.8%) and a positive predictive value of
96% (95% CI: 86.3%, 99.5%). There were no differences in complications among patients
diagnosed intraoperatively compared with those diagnosed preoperatively.
Conclusion Most patients undergoing cesarean hysterectomy for placenta accreta do have this
diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta
was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative
vigilance is required as the need for cesarean hysterectomy may not be anticipated
preoperatively.
Keywords
placenta accreta - cesarean hysterectomy - clinicopathological outcomes - clinical
diagnosis
