Treatment and outcome of placenta percreta: Primary cesarean hysterectomy versus conservative management

Licon, Ernesto; Matsuzaki, Shinya; Opara, Karen N.; Machida, Hiroko; Roman, Lynda D.; Sasso, Elizabeth B.; Matsuo, Koji

doi:10.1016/j.ejogrb.2019.09.017

Cited by 9 publications

(3 citation statements)

References 7 publications

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“…Women who underwent intra‐arterial balloon occlusion in these subgroups specifically were less likely to experience hemorrhage, require a blood transfusion, and have a urinary tract injury. The magnitude of risk reduction is clinically compelling as surgical morbidity for placenta increta/percreta is generally devastating 26,27 . Our observation partly validates a previous study demonstrating reduced surgical blood loss and blood product use with intra‐arterial balloon use 13 .…”

Section: Discussionsupporting

confidence: 84%

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Matsuo

Matsuzaki

Vestal

et al. 2021

Acta Obstet Gynecol Scand

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Introduction This study examined national‐level trends, characteristics, and perioperative outcomes of women who had intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum (PAS). Material and methods This was a population‐based retrospective observational study that queried the National Inpatient Sample from October 2015 to December 2018. Study population was women who underwent hysterectomy at cesarean delivery for PAS (n = 6440 in 806 centers). Exposure allocation was the use of intra‐arterial balloon occlusion. Main outcome measures were (a) characteristics associated with intra‐arterial balloon occlusion use, and (b) perioperative outcome including hemorrhage, blood transfusion, coagulopathy, shock, urinary tract injury, intra‐arterial balloon occlusion‐related complication (arterial injury, arterial thrombosis, and lower extremities ischemia), and death, assessed in multivariable analysis. Results Intra‐arterial balloon occlusion was used in 420 (6.5%) women in 64 (7.9%) centers. Utilization of intra‐arterial balloon occlusion during cesarean hysterectomy for placenta accreta decreased significantly over time (from 6.3% to 3.1%, p < 0.001), but not in placenta increta (from 12.8% to 9.3%, p = 0.204) or placenta percreta (from 21.3% to 17.5%, p = 0.344). In a multivariable analysis, patient factors (younger age, earlier year, obesity, diabetes mellitus), pregnancy factors (placenta increta/percreta, previous cesarean delivery, placenta previa, and early gestational age), and facility factors (large bed capacity, urban teaching status, and Northeast/West regions) represented the independent characteristics for using the intra‐arterial balloon occlusion (all, p < 0.05). In a classification‐tree model, the absolute difference in intra‐arterial balloon occlusion use among 18 utilization patterns was 48% (range, 0%–48%). In perioperative outcome analysis, women who received intra‐arterial balloon occlusion were more likely to have coagulopathy (adjusted odds ratio [aOR] 3.43) and arterial thrombosis (aOR 9.82) in placenta accreta, but less likely to have hemorrhage (aOR 0.25) in placenta increta, and blood transfusion (aOR 0.60) and urinary tract injury (aOR 0.28) in placenta percreta compared with those who did not (all, p < 0.05). Conclusions There is a wide range in the utilization of intra‐arterial balloon occlusion at cesarean hysterectomy for PAS based on patient, pregnancy, and facility factors, which implies that there is a lack of universal practice guidelines in this surgical procedure. Whether the use of intra‐arterial balloon occlusion in the severe forms of PAS improves surgical outcome merits further investigation.

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Section: Discussionsupporting

confidence: 84%

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Matsuo

Matsuzaki

Vestal

et al. 2021

Acta Obstet Gynecol Scand

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“…Caesarean hysterectomy has traditionally been the recommended treatment in these cases [ 6 ], but other treatment options have been explored over the decades [ 7 , 15 ]. Several studies have demonstrated the advantages of leaving the placenta in situ including reductions in the rate of hysterectomy [ 16 , 24 , 25 ], blood loss [ 16 , 25 , 26 ], transfusion of blood products [ 16 , 24 , 27 ], cystotomy [ 26 ], and disseminated intravascular coagulation [ 24 ]. In a multicentre retrospective study including 167 cases of PAS managed by leaving the placenta in situ, the rate of serious maternal morbidity was 6% and one maternal death (0.6%) was observed [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

A Single-Centre Retrospective Analysis of Pregnancies with Placenta Accreta Spectrum (PAS): From One-Step Surgery towards Two-Step Surgical Approach

Weydandt,

Lia,

Schöne

et al. 2024

JCM

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Background: Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimise blood loss. Methods: We conducted a single-centre retrospective cohort study including all patients managed for PAS between 2007 and 2023. The number of units of red blood cells (RBCs) needed during surgery was the primary outcome used to compare these two approaches. Results: A total of 43 cases were included in this analysis. Twenty of these were managed with the delayed two-step surgical approach, whereas 23 received one-step surgery. The median estimated blood loss during surgery was 2000 mL and 2800 mL for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach, the median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBCs was 0.28 (95%-CI: 0.08–0.98, p = 0.043). A longer interval between the caesarean section and the second operation showed a trend toward lower blood loss (p = 0.065) and was associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusions: Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction in blood transfusion. Leaving the placenta in situ and delaying the final operation represents a possible alternative to traditional caesarean hysterectomy.

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“…Over the following decades various clinicians and scientists have gathered data to further elucidate the safety and effectiveness of this treatment option. Several studies were able to show that leaving the placenta in situ had a favourable effect on the rate of hysterectomy (17)(18)(19), blood loss (17,19,20), transfusion of red blood cells (17,18,21) and fresh frozen plasma (18), cystotomy (20), and disseminated intravascular coagulation (18). In a multicentre study retrospective study including 167 cases of PAS managed by leaving the placenta in situ, the rate of serious maternal morbidity was 6% and one maternal death (0.6%) was observed (22).…”

Section: Discussionmentioning

confidence: 99%

A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach

Weydandt,

Lia,

Schöne

et al. 2023

Preprint

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Background Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimize blood loss. Methods We conducted a monocentric retrospective cohort study including all patients operated for PAS between 2006 and 2023. During this period, one-step surgery was abandoned and a two-step surgical approach was adopted. The number of units of red blood cells (RBC) needed during surgery were the primary outcomes used to compare these two approaches. Results A total of 43 cases were included in this analysis. Median blood loss during surgery was 2000 ml and 2800 ml for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBC was 0.28 (95%-CI: 0.063 ‒ 1.15, p = 0.067). Longer interval between the caesarean section and the second operation showed a trend to lower blood loss (p = 0.065) and were associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusion Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction of blood transfusion. Leaving the placenta in situ and delay final operation represents a possible alternative to traditional cesarean hysterectomy (one-step surgery).

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Treatment and outcome of placenta percreta: Primary cesarean hysterectomy versus conservative management

Cited by 9 publications

References 7 publications

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

A Single-Centre Retrospective Analysis of Pregnancies with Placenta Accreta Spectrum (PAS): From One-Step Surgery towards Two-Step Surgical Approach

A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach

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