Peripartum Cesarean Hysterectomy for Placenta Percreta: A Retrospective Analysis of Cases With and Without Extrauterine Disease.

Objective The aim of this study was to compare maternal morbidity and prenatal characteristics in placenta percreta cases with extrauterine disease and those with disease confined to the uterus. Methods A retrospective analysis of prospectively collected data was done at a large tertiary referral center in Egypt from October 2018 through February 2023. A total number of 73 cases who underwent primary cesarean hysterectomy with intrapartum confirmation of placenta previa percreta where there was evidence of at least placental invasion through uterine serosa (International Federation of Gynecology and Obstetrics (FIGO) grade 3) were included. Women without extrauterine disease (FIGO grade 3a) were compared to women with extrauterine disease where there was evidence of invasion of the bladder, parametrium, or both (FIGO grades 3b and 3c). Results Of 73 women included in the study, 46 women showed no evidence of extrauterine disease (group A), while the remaining 27 women had extrauterine disease (group B). The estimated amount of blood loss (mL) was 1,972 ± 671 in group A compared with 3,544 ± 899 in group B. There were no cases requiring massive transfusion in group A compared with eight of 27 cases (29.6%) in group B. Only two cases (4.3%) in group A had bladder injuries compared with 12 cases (44.4%) in group B. All 27 cases in group B required additional measures to control ongoing pelvic bleeding after hysterectomy compared with none of the cases in group A. The operating time (minutes) was 184 ± 30 in group A compared with 254 ± 42 in group B. Only five cases (10.9 %) in group A required postoperative intensive care unit admission, compared with 13 cases (48.1%) in group B. Conclusion Placenta accreta spectrum (PAS) with extrauterine disease represents the ultimate level of PAS surgery as it is more difficult, complex, and associated with the highest maternal morbidity. Highly specialized PAS centers are advised to categorize the disease into two different entities: PAS with extrauterine disease and PAS with disease confined to the uterus, as this may aid in improving the diagnostic accuracy of the severest PAS cases.