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Clinical Trial
. 2023 Aug 26;23(1):615.
doi: 10.1186/s12884-023-05923-9.

Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study

Wenxia Pan #  1 , Juan Chen #  1 , Yinrui Zou #  2 , Kun Yang  1 , Qingfeng Liu  1 , Meiying Sun  1 , Dan Li  3 , Ping Zhang  4 , Shixia Yue  5 , Yuqiang Huang  6 , Zhaoxi Wang  7
Affiliations
Clinical Trial

Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study

Wenxia Pan et al. BMC Pregnancy Childbirth. .

Abstract

Background: The two-child policy implemented in China resulted in a surge of high-risk pregnancies among advanced maternal aged women and presented a window of opportunity to identify a large number of placenta accreta spectrum (PAS) cases, which often invoke severe blood loss and hysterectomy. We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning.

Methods: Cross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL + CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018.

Results: From a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL + CST had a significant reduction in intraoperative blood loss (β=-312 ml, P < .001), RBC transfusion (β=-1.08 unit, P = .001), but required more surgery time (β = 16.43 min, P = .01). MRI-measured placenta thickness, when above 50 mm, can increase blood loss (β = 315 ml, P = .01), RBC transfusion (β = 1.28 unit, P = .01), surgery time (β = 48.84 min, P < .001) and hospital stay (β = 2.58 day, P < .001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation.

Conclusions: A conservative surgical management approach of UAL + CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery.

Clinical trial registration number: ChiCTR2000035202.

Keywords: Conservative management; Placenta accreta spectrum; Placenta previa; Uterus preservation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a. Schematic diagram of uterine artery ligation (UAL); b. Schematic diagram of clover suturing technique (CST); c. Picture of a uterus after UAL + CST
See this image and copyright information in PMC

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References

    1. Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S, Diagnosis FPA, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146(1):20–4. doi: 10.1002/ijgo.12761. - DOI - PubMed
    1. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75–87. doi: 10.1016/j.ajog.2017.05.067. - DOI - PubMed
    1. Jauniaux E, Ayres-de-Campos D, Diagnosis FPA. Management Expert Consensus P. FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet. 2018;140(3):261–4. doi: 10.1002/ijgo.12406. - DOI - PubMed
    1. Bowman ZS, Eller AG, Bardsley TR, Greene T, Varner MW, Silver RM. Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol. 2014;31(9):799–804. - PubMed
    1. Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol. 2013;208(3):219e1–7. doi: 10.1016/j.ajog.2012.12.037. - DOI - PubMed

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