Study on outcomes of pregnancy in women with placenta accreta spectrum: A 10-year study in a tertiary care center

Abstract

Introduction: Placenta accreta spectrum (PAS) disorders include accreta, increta, and percreta, which are associated with increased maternal morbidity and mortality. Obstetric hysterectomy for PAS disorders is more associated with massive obstetric hemorrhage than the conservative management methods. Aim: To study the outcomes in women with PAS in a tertiary care center—uterine preservation (conservative) versus obstetric hysterectomy with arterial embolization. Materials and methods: The patients were divided into three groups: group I included women in whom placenta left in situ with uterine artery embolization ( UAE) done, group II included women with partial accreta undergone placenta removal followed by UAE, and group III included women who underwent obstetric hysterectomy with arterial embolization. Results: A total of 43 women were included in this study between 2010 and 2020. Among 43 women, 28 (65.11%) had accreta, 10 (23.25%) had increta, and 5 (11.62%) had percreta. Group I had 24 (55.81%) women managed by leaving the placenta in situ with UAE done. Group II had 9 (20.93%) women undergone placental removal in toto followed by UAE, and group III had 10 (23.25%) women who underwent obstetric hysterectomy with arterial embolization. The outcomes were studied among the three groups in terms of the amount of intrapartum blood loss, ICU admissions, prolonged hospital stay, bladder injury, and disseminated intravascular coagulation. The blood loss and postoperative complications were more in group III, which was statistically significant (p < 0.0001). There was no maternal mortality in our study. Conclusion: Conservative management by leaving the placenta in situ with arterial embolization helps women to retain the uterus and reduces maternal morbidity in PAS disorders.