Complicated placenta accreta spectrum: identifying a high-risk cohort

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Placenta accreta spectrum (PAS) is a condition where placental tissue invades the uterine wall.
• Complicating factors in PAS can include bleeding, preterm premature rupture of membranes (PPROM), and preterm contractions.

Purpose of the Study:

• To compare perioperative complication rates in patients with PAS with and without complicating factors.
• To identify specific risks and outcomes associated with complicated PAS.

Main Methods:

• Retrospective cohort study of patients with histology-proven PAS undergoing cesarean hysterectomy.
• Comparison of perioperative outcomes between uncomplicated PAS and complicated PAS (defined by ≥2 bleeding episodes, PPROM, or preterm contractions).

Main Results:

• No significant difference in overall perioperative complications between complicated and uncomplicated PAS groups.
• Complicated PAS cases showed increased need for blood product transfusion before delivery (p=0.001).
• Earlier delivery (median GA 30.9 vs 34.9 weeks, p<0.001), lower birthweights, and longer maternal length of stay were observed in complicated PAS.

Conclusions:

• Complicated PAS does not increase the risk of perioperative complications.
• Complicated PAS is associated with earlier delivery, increased antenatal transfusions, and prolonged maternal length of stay.