Risk Factors for Peripartum Hysterectomy Among Pregnancies with Suspected Placenta Accreta Spectrum in Preoperative Obstetric Imaging Screening: a Retrospective Cohort Study

Abstract

Objective: This study aimed to identify risk factors for peripartum hysterectomy among pregnancies complicated by suspected Placenta Accreta Spectrum (PAS) in preoperative obstetric imaging screening. Methods: Data were retrospectively extracted from the Longitudinal Placenta Accreta Spectrum Study (LoPASS), covering pregnancies with PAS from January 2018 to March 2023 at our institute. Patients were divided into Control and Hysterectomy groups based on whether they underwent hysterectomy. Sociodemographic, obstetric, and clinical characteristics were compared between the groups. Multivariate logistic regression analysis was performed on the characteristics with statistical significance to explore risk factors for peripartum hysterectomy. Results: Among 523 pregnancies with suspected PAS, 20 underwent hysterectomy. The Hysterectomy group had a significantly higher mean age (34.50±5.05 vs. 31.66±4.43 years, p=0.005) and pre-pregnancy BMI (26.35±3.27 vs. 23.84±3.99, p=0.006). The Hysterectomy group also had a higher proportion of patients with more than 2 gravidities (100% vs. 61.6%, p=0.022) and multiple parities (90.0% vs. 39.9%, p<0.001). Higher percentages of placenta percreta (90.0% vs. 28.2%, p<0.001), placenta attaching to the anterior uterine wall (57.9% vs. 31.8%, p=0.033), and higher PAS ultrasonographic scores (11.42±2.54 vs. 6.21±2.55, p<0.0001) were observed in the Hysterectomy group. Perioperative outcomes revealed significantly longer surgical durations (171.90±49.27 vs. 53.46±24.41 minutes, p<0.001) and higher rates of preterm birth (100.0% vs. 55.3%, p<0.001). Intraoperative blood loss was also substantially greater in the Hysterectomy group (2695.00±1241.17 ml vs. 764.31±385.10 ml, p<0.001). Variables significantly associated with increased peripartum hysterectomy risk included prior cesarean sections (OR=1.44, p=0.048), placenta attaching to the anterior uterine wall (OR=0.73, p=0.015), placenta completely covering the uterine incision (OR=1.27, p=0.035), gestational hypertensive disorder (OR=1.69, p=0.042), placenta percreta (OR=2.31, p=0.032), and PAS ultrasonographic score higher than 10 (OR=2.71, p=0.008). Conclusion: Prior cesarean sections, placenta location, gestational hypertensive disorder, placenta percreta, and a PAS ultrasonographic score higher than 10 are risk factors for peripartum hysterectomy in pregnancies with suspected PAS. This underscores the importance of early and consistent obstetric imaging examinations of the placenta and active preparation for emergency cesarean sections in such pregnancies.