Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Saad El Gelany, Mohammed H Mosbeh, Emad M Ibrahim, Mo'men Mohammed, Eissa M Khalifa, Ahmed K Abdelhakium, Ayman M Yousef, Heba Hassan, Khaled Goma, Ahmed Abd Alghany, Hashem Fares Mohammed, Ahmed M Azmy, Wegdan A Ali, Ahmed R Abdelraheim, Saad El Gelany, Mohammed H Mosbeh, Emad M Ibrahim, Mo'men Mohammed, Eissa M Khalifa, Ahmed K Abdelhakium, Ayman M Yousef, Heba Hassan, Khaled Goma, Ahmed Abd Alghany, Hashem Fares Mohammed, Ahmed M Azmy, Wegdan A Ali, Ahmed R Abdelraheim

Abstract

Background: Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt.

Methods: This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place.

Results: The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate.

Conclusions: The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling.

Trial registration: Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Keywords: Cervix; Placenta accreta spectrum; Tamponade.

Conflict of interest statement

The authors declare that they have no competing interests.

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