Poster Session 3
Nirit Maliyanker, MD (she/her/hers)
Sheba Medical Center
Givatayim, Tel Aviv, Israel
Elias Cstel, MD
Sheba Medical Center
Ramat gan, HaMerkaz, Israel
Nizan Mor, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Lior Fridrich, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Shlomi Toussia Cohen, MD (he/him/his)
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Aviran Ohayon, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Alina Weissmann-Brenner, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Gabriel Levin, MD
McGill University
Montreal, Quebec, Canada
Raanan Meyer, MD
Cedars Sinai Medical Center
Los Angeles, California, United States
Uterine preserving cesarean delivery is increasingly used to manage placenta accreta spectrum (PAS). Outcomes of emergent compared to elective cesarean hysterectomy were previously studied. The aim of this study is to compare maternal and neonatal outcomes between women who had emergent and elective uterine preserving cesarean delivery for PAS cases.
Study Design:
This is a retrospective study conducted at a single tertiary center. PAS cases scheduled for uterine preserving surgery between 3/2011 to 11/2020 were retrieved and analyzed. Delivery was defined as elective when performed at a time and date planned by a dedicated multidisciplinary team, all other cases were defined as emergent. The primary outcome is composite maternal outcome defined by one or more of these variables: unplanned hysterectomy, intensive care unit admission, transfusion of six or more red blood cell units, disseminated intra-vascular coagulation. ureteric injury, bowel injury, unintentional cystotomy and relaparotomy. Secondary outcome included neonatal outcome such as APGAR score, cord pH, admission to the neonatal intensive care and mechanical ventilation.
Results:
274 women with PAS diagnosis were scheduled to uterine preserving surgery. 215 underwent elective surgery and 59 had emergent surgery. Composite maternal outcome occurred in 81 women (29.6%) of all women, no significant difference was found between the elective surgery group and the emergent surgery group (28.8% vs 32.2% p=0.631). Significant differences were found in neonatal outcomes: longer hospital stay (8.42 ± 7.06 vs 16.28 ± 13.98 p< 0.01), higher rate of mechanical ventilation (7% vs 18.6% p< 0.01) and neonatal intensive care unit hospitalization in the emergent cesarean group (24.2% vs 55.9% p< 0.01).
Conclusion:
Emergent uterine preserving surgery in PAS cases is not associated with increased maternal morbidity. This should be considered against prematurity complication when scheduling uterine preserving surgery. Higher rate of neonatal adverse outcomes was found in the emergency group can be attributed to an earlier gestational week at delivery.
