Severe maternal morbidity following Cesarean hysterectomy for placenta accreta spectrum: a historical cohort study

We sought to evaluate the incidence of severe maternal morbidity (SMM) and intensive care unit (ICU) admissions following Cesarean hysterectomy for placenta accreta spectrum (PAS) and to assess factors associated with those outcomes.

We conducted a historical cohort study to identify patients with PAS who had Cesarean hysterectomy in the USA using delivery hospitalizations in the Premier Inc. database (Charlotte, NC, USA) from 1 October 2015 to 30 June 2021. We collected information about the 21 SMM events as defined by the Centers for Disease Control and Prevention. Since hysterectomy is one of those SMM events, and all patients in our cohort underwent hysterectomy, we assessed SMM events, excluding hysterectomy, using International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnosis codes. We performed mixed-effects logistic regression models with random intercepts for hospitals to assess for factors associated with SMM.

Among 1,972 patients, SMM (excluding hysterectomy) and ICU admission occurred in 54% and 44% of the patients, respectively. The following factors were associated with SMM: placenta percreta compared with accreta (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.09 to 1.95), blood loss anemia (OR, 1.71; 95% CI, 1.26 to 2.33), deficiency anemia (OR, 0.64; 95% CI, 0.43 to 0.96), neuraxial compared with general anesthesia (OR, 0.64; 95% CI, 0.44 to 0.91), admission year (OR, 0.73; 95% CI, 0.68 to 0.80), and hospitals in the Midwest (OR, 0.56, 95% CI, 0.33 to 0.96) and West (OR, 0.47, 95% CI, 0.26 to 0.84) regions of the USA compared with those in the South.

Patients with PAS who underwent Cesarean hysterectomy had a high incidence of SMM and ICU admissions. This finding highlights the need for all centres performing Cesarean deliveries to have plans in place to manage patients with PAS.