Key takeaways:
- For most girls with placenta accreta spectrum dysfunction, leaving the placenta in situ didn’t result in severe problems.
- This can be an alternative choice to cesarean hysterectomy for some girls.
MINNEAPOLIS — In a small research, most girls with placenta accreta spectrum dysfunction who had their placenta left in situ didn’t expertise infections or bleeding requiring a hysterectomy.
The findings have been introduced on the ACOG Annual Medical & Scientific Assembly and printed in Obstetrics & Gynecology.
In a small research, most girls with placenta accreta spectrum dysfunction who had their placenta left in situ didn’t expertise infections or bleeding requiring a hysterectomy. Picture: Adobe Inventory
Based on Farah Hassan Amro, MD, chief of scientific observe at ACOG and an assistant professor within the division of OB/GYN and reproductive sciences on the College of Texas, Well being Science Middle at Houston, the incidence of placenta accreta spectrum (PAS) dysfunction is growing, primarily resulting from increased cesarean supply charges.
At the moment, ACOG recommends cesarean hysterectomy to handle PAS, with all different approaches thought of investigational or experimental, Amro famous.
“There have been a number of different approaches which have been proposed for managing PAS. A few of these approaches have been proposed internationally. They embody eradicating the placenta with oversewing the placental mattress in addition to a receptive reconstructive method, which entails eradicating the placenta in addition to the uterine myometrium,” Amro mentioned through the presentation. “There are additionally some approaches which have been proposed nationally. A type of approaches is performing a delayed hysterectomy, which entails performing a cesarean part, leaving the placenta in situ, after which performing the hysterectomy 4 to six weeks postpartum.”
Amro and colleagues performed a single-center retrospective cohort research from January 2015 to October 2024. Their evaluation included 180 girls with PAS, 50 of whom have been deliberate to be managed by leaving the placenta in situ. The researchers evaluated maternal outcomes after leaving the placenta in situ, together with an infection threat, important bleeding leading to hysterectomy, transfusion charges and severe maternal morbidity.
Total, 43 girls have been managed by leaving the placenta in situ and 14% underwent cesarean hysterectomy resulting from antepartum or intraoperative hemorrhage. Of those that had their placenta left in situ (imply age, 34 years), 12% had bleeding requiring a hysterectomy and 9% had endometriosis.
Of 29 girls who deliberate for uterine preservation, 45% have been profitable, with a median time of 17 weeks to expulsion or resorption, and 55% underwent interval hysterectomy.
In contrast with girls who finally underwent an interval hysterectomy, those that had profitable uterine preservation had much less blood loss (median estimated complete blood loss, 700 vs. 1,950 mL; P < .01), decrease transfusion charges (31% vs. 73%; P < .01) and fewer transfusions exceeding 4 items (8% vs. 47%; P = .01). 5 girls had subsequent pregnancies with out placenta previa or PAS.
The researchers mentioned there have been no instances of venous thromboembolism or deaths.
“Leaving the placenta in situ could also be acceptable to supply as an alternative choice to cesarean hysterectomy in choose instances,” Amro mentioned. “Nevertheless, our information have to be interpreted with warning given the small pattern dimension, which might doubtlessly preclude detection of uncommon however doubtlessly severe problems.”
