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

Lior Friedrich; Nitzan Mor; Alina Weissmann-Brenner; Eran Kassif; Shakad Noah Friedrich; Tal Weissbach; Elias Castel; Gabriel Levin; Raanan Meyer

doi:10.1055/a-2486-9070

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(10): 1288-1294
DOI: 10.1055/a-2486-9070

Original Article

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

Lior Friedrich

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

,

Nitzan Mor

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

,

Alina Weissmann-Brenner

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

,

Eran Kassif

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

,

Shakad Noah Friedrich

³Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel

,

Tal Weissbach

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

,

Elias Castel

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

,

Gabriel Levin

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

⁵Faculty of Medicine, Hebrew University, Jerusalem, Israel

,

Raanan Meyer

¹School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

²Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

⁶Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel

› Author Affiliations

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

Full Text

References

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