Subsequent pregnancy outcomes following conservative management for placenta accreta spectrum disorders: an ambispective cohort study.

Abstract

Background: Placenta accreta spectrum disorders (PAS), a devastating obstetric complication, has increased dramatically in recent decades along with the growing rate of cesarean worldwide. Various conservative management techniques, aimed to avoid hysterectomy and potentially preserve fertility, have been implemented in the management of PAS. However, reports on subsequent pregnancy outcomes following conservative management for PAS are limited.

Objective: To systematically evaluate the subsequent pregnancy outcomes in PAS patients undergoing conservative management.

Methods: This was a single-center, ambispective cohort study conducted between January 2013 to March 2021. Follow-ups were conducted annually, extending until March 2023. Eligible patients were PAS patients who underwent successful conservative treatment and had intentions for future fertility. Baseline characteristics, conservative management strategies, and subsequent pregnancy outcomes were collected and analyzed. Primary outcome was the subsequent pregnancy outcomes, including interpregnancy interval, conceive method, pregnancy success rate, pregnancy and delivery outcomes, and major maternal morbidities.

Results: A total of 40 patients with conservatively managed PAS and attempting subsequent pregnancies were included. These patients were further divided into the subsequent pregnancy group (n = 28) and non-pregnancy group (n = 12). There were no significant differences in term of baseline characteristics, conservative management, and delivery outcome between the two groups(All p < 0.05). The menstrual resumption time was 4.5 (2.25-6.00) months, and the interpregnancy interval was 39.7 ± 26.4 months. In the subsequent pregnancy, 28 patients experienced at least one pregnancy, with a total of 43 subsequent pregnancies. Ultimately, 60% (24/40) of patients successfully delivered but with a PAS recurrence of 33.3% (8/24). Major maternal morbidity included postpartum hemorrhage (PPH) (25%), disseminated intravascular coagulation (12.5%), uterine rupture (4.2%) and hysterectomy (4.2%). Furthermore, the incidence of composite adverse delivery outcomes was 45.8% (11/24). Neonatal outcomes were generally favorable, with a full-term birth rate of 87.5% and live birth rate of 95.8% (23/24).

Conclusion: Our findings reveal that while conservative management for PAS does not compromise subsequent fertility, it does pose substantial risks in subsequent pregnancies, including high recurrence rates of PAS, significant PPH, and increased incidence of composite adverse delivery outcomes. Patients should be thoroughly informed of the related risks and subsequent pregnancies necessitate comprehensive preconception counseling, meticulous antenatal care and individualized management strategies to minimize these risks.