Ultrasound-first, anatomy-based algorithm to tailor the extent of hysterectomy in placenta accreta spectrum

Area of Science:

• Obstetrics and Gynecology
• Surgical Oncology
• Radiology

Background:

• Placenta accreta spectrum (PAS) poses significant surgical challenges.
• Cesarean hysterectomy is standard for suspected placenta percreta, but criteria for cervical management are unclear.

Purpose of the Study:

• To propose an anatomy-based framework for tailoring hysterectomy extent in PAS.
• To integrate preoperative imaging with intraoperative assessment for surgical planning.

Main Methods:

• Ultrasound is the primary imaging modality, assessing placental location, invasion depth, and cervical/vesicouterine interface.
• MRI is used selectively for uncertain cervical or bladder invasion.
• A stepwise, ultrasound-first algorithm guides decisions between total and subtotal hysterectomy.

Main Results:

• The framework translates imaging findings into actionable surgical criteria.
• Subtotal hysterectomy may be a safe alternative to total hysterectomy in selected PAS cases meeting strict anatomic criteria.
• This approach aims to improve reproducibility and standardization in PAS management.

Conclusions:

• The proposed framework operationalizes decision-making for hysterectomy extent in PAS.
• Selected cases may benefit from subtotal hysterectomy, potentially reducing morbidity.
• Further validation in larger cohorts is needed to confirm clinical utility.