PDF icon Download PDF
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 
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
2   Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
Elias Castel
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
2   Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
Lior Friedrich
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
3   Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
,
Nitzan Mor
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
2   Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
Gabriel Levin
4   Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel
,
Raanan Meyer 
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
2   Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
Shlomi Toussia-Cohen
1   Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
2   Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
› Author Affiliations
Funding None.
› Further Information
Also available ateRefHebammen
   Permissions and Reprints
Preview

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

Authors' Contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by A.O. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


A.O.: Protocol/project development; Data collection and management; Data analysis; Manuscript writing/editing.


E.C.: Protocol/project development; Data collection and management.


L.F.: Data collection and management; Data analysis.


N.M.: Data collection and management; Data analysis.


G.L.: Data collection and management; Data analysis.


R.M.: Protocol/project development; Data collection or management; Data analysis; Manuscript writing/editing.


S.T-C.: Protocol/project development; Data collection or management; Data analysis; Manuscript writing/editing.


Ethical Approval

The Institutional Review Board of the Sheba Medical Center approved the study protocol under the reference number 9805-22-SMC.


The study received approval from the Institutional Review Board (9805-22-SMC) to waive informed consent. Additionally, the Institutional Review Board granted retrospective access to the patient database for the study and approved the telephone calls to obtain missing data.




Publication History

Received: 24 March 2024

Accepted: 12 May 2024

Article published online:
10 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA