obstetric Hysterectomy versus Conservative Surgery For the management of patients with placenta accreta spectrum . | ||
| Evidence Based Women's Health Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 30 September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ebwhj.2025.428423.1517 | ||
| Authors | ||
| Malames Mahmoud Salama* 1; Mohamed Ahmed Elkadi2; noha abdelsattar3; wesam elsayed4 | ||
| 1Obstetric and gynecology , faculty of medicine , ain Shams university | ||
| 2Obstetrics and Gynaecology,Faculty of Medicine,Ain Shams University, Cairo Egypt | ||
| 3department of obstetrics and gynecology , faculty of medicine , Ian shams university | ||
| 4department of obstetrics and gynecology , faculty of medicine , ain shams university | ||
| Abstract | ||
| ABSTRACT Background: Placenta accreta is described as deep adherence of placental villi to the myometrium. It is caused by a defect in decidua basalis resulting in an abnormally invasive placental implantation. Methods: A retrospective study (from Jan 2011 to Jan 2017) including 491 cases of placenta accreta, increta or percreta managed on non-emergency basis by either conservative surgery or hysterectomy . During the study period, 223 cases were managed by hysterectomy and 268 cases by conservative uterine surgery. Results: Conservative surgery was associated with lower maternal morbidity compared to hysterectomy in the form of less blood loss (1498 ± 1537 ml versus 2778 ± 1998ml), a lower percentage of patients who received blood transfusion (78.0%) versus (96.4%), fewer transfused blood units (3.6 ± 3.3 versus 6.1 ± 4.8) and a lower insidance of urinary tract injury (7.8%) versus (27.8%). Conservative surgery required significantly less operative time (1.3 ± 0.4 hours versus 3.2 ± 0.7 hours) and shorter hospital stays (4.7 ± 4.0 days versus 6.8 ± 5.9 days). Conclusions:. Conservative uterine surgery for placenta accreta spectrum (PAS) is a good alternative to obstetric hysterectomy, and it is associated with lower maternal morbidity. This approach may be strongly considered in cases of hemodynamic stability with the desire to preserve fertility. | ||
| Keywords | ||
| Maternal; Hemorrhage; increta; percreta; Fertility preservation | ||
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