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Am J Perinatol
DOI: 10.1055/a-2615-5098
Original Article

Outcomes of Total Abdominal Hysterectomy Compared to Supracervical Hysterectomy for Management of Placenta Accreta Spectrum

Alexandra D. Forrest 
1   Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
,
Debra Eluobaju
1   Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
,
Amanda Finney
2   Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Laura Prichett
2   Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Nicole R. Gavin
3   Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, University of Connecticut, Mansfield, Connecticut
,
Christopher Novak
1   Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
,
Kristin Martin
1   Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
,
Arthur Jason Vaught
1   Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
Funding None.
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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


Publication History

Received: 28 March 2025

Accepted: 18 May 2025

Accepted Manuscript online:
19 May 2025

Article published online:
03 June 2025

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