(173) Severe Maternal Morbidity from Peripartum Hysterectomy: Is there a difference between accreta and non-accreta cases?

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Devesh Naidoo, MD

Fellow
MemorialCare Miller Children's and Women's Hospital Long Beach University of California Irvine
Long Beach, CA, United States

Coauthor(s)

Vineet Shrivastava, MD

MemorialCare Miller's Children's and Women's Hospital
Long Beach, California, United States
Megan C. Oakes, MD, MSCI (she/her/hers)

Maternal-Fetal Medicine
MemorialCare Miller Children's and Women's Hospital Long Beach
Long Beach , CA, United States

Objective: Evaluate the difference in rates of severe maternal morbidity (SMM) among patients undergoing peripartum hysterectomy for placenta accreta spectrum (PAS) compared to non-PAS indications.

Study Design: This was a retrospective cohort study of all patients who had a peripartum hysterectomy performed at an urban, tertiary care hospital from 1/1/2010-6/30/2023. Patients with a preoperative diagnosis of suspected PAS were compared to those who underwent peripartum hysterectomy for non-PAS indications, such as uterine atony. The primary outcome was composite SMM. Secondary outcomes included individual maternal morbidities and mortality. A planned subgroup analysis comparing unscheduled, peripartum hysterectomy for PAS compared to non-PAS peripartum hysterectomy was conducted. Chi-square and Fisher’s exact were used as appropriate.

Results: 125 patients underwent peripartum hysterectomy during the specified period, 63 (50.4%) for suspected PAS and 62 (49.6%) for non-PAS indications. Those who underwent peripartum hysterectomy for non-PAS cases had a significantly higher SMM rate compared to suspected PAS cases (96.7% vs 85.7%, p=0.03). This was largely driven by transfusion (96.7% vs 85.7%, p=0.03), as non-transfusion SMM did not differ between the groups (67.7% vs 68.2%, p=0.95). Only bowel and bladder injury were noted to be different between the groups, with more events in the suspected PAS group (26.9% vs 6.4%, p< 0.05). In a subgroup analysis comparing unscheduled, peripartum hysterectomy for PAS (n=24) compared to non-PAS cases, there was no difference in composite SMM between the groups (100% vs 96.7%, p=0.37).

Conclusion: Composite SMM was higher in cases of non-PAS peripartum hysterectomy compared to suspected PAS cases, driven exclusively by higher rates of blood transfusion. However, this difference disappears when comparing non-PAS hysterectomy to unscheduled, peripartum hysterectomy for suspected PAS. While both groups have high rates of SMM, this highlights the difference that preparation can have for planned peripartum hysterectomy for suspected PAS cases.