A low-middle income country experience: conventional hysterectomy vs conservative placenta accreta spectrum management

Abstract

BACKGROUND

Placenta accreta spectrum is one of the most dangerous complications of pregnancy, and its incidence has been rising in recent years. The standard management approach is an elective cesarean-hysterectomy, but it presents with its own set of risks and complications. Although conservative management options exist, there is a lack of definitive guidelines and must be considered on a case-by-case basis.

OBJECTIVE

This study aimed to describe and compare the outcomes (surgical duration, intraoperative blood loss volume, and maternal mortality) of patients with placenta accreta spectrum who were treated with a hysterectomy and those treated with conservative surgery in the Dr. Cipto Mangunkusumo General Hospital, a tertiary referral hospital in Indonesia.

STUDY DESIGN

Data from 271 patients with placenta accreta spectrum at the Dr. Cipto Mangunkusumo General Hospital that were collected over 3.5 years were taken and analyzed in this retrospective cohort study. Data collected included the patients’ age, reproductive history, placenta accreta index score, gestational age, emergency status, management method, type of hysterectomy, surgery duration, intraoperative blood loss volume, histopathologic data, and maternal mortality. The data were analyzed using the Statistical Package for Social Sciences, version 29, with statistical significance set at P<.05. Mann-Whitney U tests, independent t tests, chi-square tests, and correlation tests were used where appropriate.

RESULTS

There were no significant differences in the demographics and reproductive history between the hysterectomy and conservative surgery groups. There was considerable difference in terms of surgical duration, intraoperative blood loss, and placenta accreta index score. The hysterectomy group had longer surgeries (median 180 minutes vs 135 minutes; P<.01), greater blood volume lost (median 1000 mL vs 700 mL; P<.01), and higher placenta accreta index scores (median 6.5 vs 5.5; P<.01). The maternal mortality rate of this study was 1.1%, all of whom were patients from the hysterectomy group, but this finding was not statistically significant.

CONCLUSION

In this study, patients who underwent conservative surgical management for placenta accreta spectrum experienced shorter surgeries with less bleeding and no maternal death. These patients typically had lower placenta accreta index scores, which may have influenced the choice of management methods and affected surgical outcomes. Although conservative surgery is a viable option, patients and surgeons must carefully weigh the risks and benefits before deciding on a treatment approach.