Introduction The aim of this study is to compare immediate and long‐term obstetrical outcomes of patients who underwent cesarean delivery with and without uterine artery embolization (UAE) for the management of placenta accreta spectrum disorder. Material and methods A retrospective case control study including all pregnant women admitted to a single tertiary medical center between December 2001 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long‐term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non‐parametric statistics were used. Results During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68‐110] vs 50.5 [39‐77] minutes; P = .001), and higher blood loss (2000 (1500‐3000) vs 1000 (600‐2000) mL; P = .001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P = .88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P = .02). Postoperative complications were more frequent in the UAE group. Follow up was achieved in 29 (59.18%) and 72 (51.79%) of the women with and without UAE, respectively (P = .36). No differences were found in rate of abortions, pregnancy and deliveries between the groups. Conclusions Cesarean delivery using UAE in placenta accreta spectrum disorder is associated with a higher rate of operative and postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.

No abstract

No abstract

No abstract

No abstract

Pelvic surgery has been suggested as a risk factor for decreased ovarian reserve, most probably due to impairment in ovarian blood supply. Cesarean delivery is the most frequent pelvic surgery with increasing rates worldwide, nevertheless, no data exist concerning its effect on ovarian reserve. The aim of this study is to assess the effect of cesarean delivery on ovarian reserve compared to normal vaginal delivery. STUDY DESIGN: A prospective case control study conducted in a single tertiary medical center during June 2018 to April 2019. Study population included: 1.Women with singleton pregnancy that underwent their first cesarean delivery ; 2. Control group consist of pregnant women with normal vaginal delivery. Exclusion criteria included: 1. Known low ovarian reserve 2. Endometriosis 3. Previous pelvic surgery 4. Chronic maternal disease. Ovarian reserve was estimated by Anti Mullarian Hormone (AMH) levels up to a week before and three month after the delivery. Primary outcome was defined as the delta in AMH levels. Data were analyzed in non-parametric tests. RESULTS: During the study period 63 (47%) and 72 (53%) women underwent cesarean delivery and normal vaginal delivery, respectively. Women in the cesarean delivery group were older [34 (31-38) vs. 32 (29-35); p¼0.001], with higher parity [1 (0-2) vs. 0 (0-1); p¼0.001]. Delivery was a week earlier in the cesarean delivery group [38.3 (38.2-39.4) vs. 40.2 (39.1-40.5); p¼0.001]. AMH rates were comparable between the groups before delivery [0.92 (0.51-1.79) vs. 0.95 (0.51-1.79); p¼0.42], and was more than doubled after delivery in both of the groups [2.15 (1.24-3.05) vs. 2.62 (1.05-5.09); p¼0.50]. Median delta AMH levels was was comparable between study and control groups [1.25 (0.61-2.22) vs. 1.59 (0.63-3.41), respectively; p¼0.43]. Linear regression analysis including age, parity, grouping and gestational age at delivery, revealed that only maternal age was significantly associated with delta in AMH levels (B¼-0.22, p¼0.03). CONCLUSION: Cesarean delivery was not associated with a decrease in ovarian reserve as estimated by AMH.