Loïc Sentilhes1, Aurélien Seco2, Elie Azria3, Gaël Beucher4, Marie-Pierre Bonnet5, Bernard Branger6, Lionel Carbillon7, Coralie Chiesa8, Catherine Crenn-Hebert9, Michel Dreyfus4, Corinne Dupont10, Jeanne Fresson11, Cyril Huissoud12, Bruno Langer13, Olivier Morel14, Sophie Patrier15, Franck Perrotin16, Pierre Raynal17, Patrick Rozenberg18, René-Charles Rudigoz12, Francoise Vendittelli19, Norbert Winer20, Catherine Deneux-Tharaux8, Gilles Kayem21. 1. Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France. Electronic address: loicsentilhes@hotmail.com. 2. Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Clinical Research Unit of Paris Descartes Necker Cochin, Assistance Publique Hôpitaux de Paris, Paris, France. 3. Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Maternité Notre-Dame de Bon Secours, Groupe Hospitalier Paris Saint-Joseph, Paris University, Paris, France. 4. Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France. 5. Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France. 6. "Sécurité Naissance-Naître Ensemble" Perinatal Network of the Pays de la Loire, Pays de la Loire, France. 7. "Naître dans l'Est Francilien" Perinatal Network, Sorbonne Paris North University, Villetaneuse, France. 8. Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France. 9. Department of Obstetrics and Gynecology, Louis-Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France; "Hauts de Seine" (PERINAT92) Perinatal Network, Issy-les-Moulineaux, Paris, France. 10. Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; "Aurore" Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France. 11. Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Medical Information, Nancy University Hospital, Nancy, France. 12. Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France. 13. Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France. 14. Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy, France. 15. Department of Pathology, Rouen University Hospital, Rouen, France. 16. Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France. 17. Department of Obstetrics and Gynecology, Versailles Hospital, Versailles, France. 18. Department of Obstetrics and Gynecology, Poissy University Hospital, Poissy, France. 19. Auvergne Perinatal Network, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, University Hospital of Clermont-Ferrand, Scientific Research National Center, SIGMA Clermont, Institute Pascal, Clermont-Ferrand, France. 20. Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France. 21. Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Abstract
BACKGROUND: Placenta accreta spectrum is a life-threatening condition that has increased dramatically in recent decades along with cesarean rates worldwide. Cesarean hysterectomy is widely practiced in women with placenta accreta spectrum; however, the maternal outcomes after cesarean hysterectomy have not been thoroughly compared with the maternal outcomes after alternative approaches, such as conservative management. OBJECTIVE: This study aimed to compare the severe maternal outcomes between women with placenta accreta spectrum treated with cesarean hysterectomy and those treated with conservative management (leaving the placenta in situ). STUDY DESIGN: From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. RESULTS: Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19-0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. CONCLUSION: Among women with placenta accreta spectrum who underwent cesarean delivery, conservative management was associated with a lower risk of transfusion of >4 units of packed red blood cells within 6 months than cesarean hysterectomy.
BACKGROUND: Placenta accreta spectrum is a life-threatening condition that has increased dramatically in recent decades along with cesarean rates worldwide. Cesarean hysterectomy is widely practiced in women with placenta accreta spectrum; however, the maternal outcomes after cesarean hysterectomy have not been thoroughly compared with the maternal outcomes after alternative approaches, such as conservative management. OBJECTIVE: This study aimed to compare the severe maternal outcomes between women with placenta accreta spectrum treated with cesarean hysterectomy and those treated with conservative management (leaving the placenta in situ). STUDY DESIGN: From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. RESULTS: Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19-0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. CONCLUSION: Among women with placenta accreta spectrum who underwent cesarean delivery, conservative management was associated with a lower risk of transfusion of >4 units of packed red blood cells within 6 months than cesarean hysterectomy.
Authors: Anca Maria Panaitescu; Gheorghe Peltecu; Radu Botezatu; George Iancu; Nicolae Gica Journal: Medicina (Kaunas) Date: 2022-05-19 Impact factor: 2.948