Objectives: To compare delivery outcomes of pregnancies diagnosed with placenta-accreta-syndrome (PAS) who underwent conservative treatment to patients who underwent cesarean hysterectomy.
Methods: A retrospective study of all women diagnosed with PAS treated in one tertiary medical center between 03/2011 and 11/2020 was performed. Comparison was made between conservative management during cesarean delivery and cesarean hysterectomy. Conservative management included leaving uterus with/without placenta and with/without myometrial resection.
Results: A total of 249 pregnancies (0.25 % of all deliveries) were diagnosed with PAS, 208 underwent conservative cesarean delivery and 41 had cesarean hysterectomy, 31 of them were unplanned (75.6 %). The median number of previous cesarean deliveries was significantly higher in the cesarean hysterectomy group. There was no difference in the duration from the last cesarean delivery, the presence of placenta previa, pre-operative hemoglobin or platelets levels between the pregnancies with conservative management and the cesarean hysterectomy. Significantly more pregnancies with sonographic suspicion of placenta percreta and bladder invasion had cesarean hysterectomy. Cesarean hysterectomy was significantly associated with earlier delivery, with bleeding and required significantly more blood products. There was no statistically significant difference in the rate of relaparotomy following cesarean delivery or the rate of infections. Multivariable-regression-analysis revealed a significant odds ratio of 3.38 of blood loss of >3,000 mL following cesarean hysterectomy.
Conclusions: Conservative management in delivery of PAS pregnancies is associated with less bleeding complications during surgery compared to cesarean hysterectomy.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1515/jpm-2023-0154 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Unintentional exposure to leuprolide acetate during early pregnancy with a huge intramural myoma.
BMJ Case Rep
January 2025
Department of Medicine, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA.
Leuprolide acetate is commonly used to reduce the size of myomas before surgery. Initially, it stimulates pituitary gonadotropin secretion, followed by sustained suppression of gonadal function. However, the impact on pregnancy outcomes from inadvertent exposure remains unclear.
View Article and Find Full Text PDFPlacenta accreta spectrum disorders: A Canadian tertiary care centre's experience over 10 years.
J Obstet Gynaecol Can
December 2024
University of Manitoba, Department of Obstetrics, Gynecology, and Reproductive Sciences.
Objectives: The placenta accreta spectrum disorders (PASD) are associated with significant maternal and neonatal morbidity and mortality worldwide. As cesarean delivery rates increase, so does the rate of PASD. PASD antepartum diagnosis and perioperative management are evolving, and we primarily aimed to share our tertiary care centre's institutional approach and outcomes over a decade.
View Article and Find Full Text PDFLessons learned from a case of placenta previa totalis complicated by placenta accreta spectrum: Importance of timely decision-making.
Int J Surg Case Rep
December 2024
Department of Obstetrics and Gynecology, Tishreen University, Lattakia, Syria.
Introduction And Clinical Importance: Placenta previa (PP) is characterized by abnormal placental placement in the lower uterine segment, obstructing the cervical opening. Placenta previa totalis (PPT) occurs when the placenta completely covers the internal cervical os. This condition can lead to placenta accreta spectrum (PAS), where the placenta adheres abnormally to the uterine wall, complicating separation.
View Article and Find Full Text PDFSuccessful Fertility Preservation in a Case of Low-Grade Endometrial Stromal Sarcoma: A Multidisciplinary Approach Through the Oncofertility Network.
Cureus
November 2024
Gynecologic Oncology, Hyogo College of Medicine, Nishinomiya, JPN.
Low-grade endometrial stromal sarcoma (LGESS) is a rare disease, accounting for less than 1% of all uterine malignancies. Standard treatment is total hysterectomy and bilateral tubal oophorectomy, although fertility preservation may be desirable because of the young age of onset. We document a case of fertility preservation in a 27-year-old nulligravida diagnosed with LGESS, which not only enabled the successful birth of two live infants but also underscores the efficacy of a multidisciplinary approach to patient treatment through the Hyogo Oncofertility Network (HOF-net).
View Article and Find Full Text PDFThe role of the intraplacental fetal artery in predicting the need for cesarean-hysterectomy in women at high risk for placenta accreta spectrum.
Placenta
December 2024
Ankara Etlik Lady Zübeyde Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, P.O. Box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey. Electronic address:
Introduction: Prenatal determination of placenta accreta spectrum (PAS) and its severity is crucial, as it is a highly morbid condition. The aim was to investigate the intraplacental fetal artery (IFA) as a novel ultrasonographic marker in predicting cesarean-hysterectomy need in PAS.
Methods: A prospective observational cohort study was conducted with a total of 62 women with placenta previa and ≥1 previous cesarean-section who were managed for PAS between September 2022 and January 2024.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!