Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS)
<i>Background and Objectives:</i> Management of second-trimester placenta accreta spectrum (PAS) is currently center-dependent with minimal evidence-based practices. This study aims to analyze outcomes of hysterectomy as second-trimester active management (AM) versus cesarean hysterectom...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-01-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/61/1/113 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832587999092670464 |
|---|---|
| author | Jessian L. Munoz Rachel Counts Amanda E. Lacue Kayla E. Ireland Patrick S. Ramsey Kristyn Brandi |
| author_facet | Jessian L. Munoz Rachel Counts Amanda E. Lacue Kayla E. Ireland Patrick S. Ramsey Kristyn Brandi |
| author_sort | Jessian L. Munoz |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Management of second-trimester placenta accreta spectrum (PAS) is currently center-dependent with minimal evidence-based practices. This study aims to analyze outcomes of hysterectomy as second-trimester active management (AM) versus cesarean hysterectomy as expectant management (EM) in cases of PAS with intraoperative and postoperative outcomes. <i>Materials and Methods:</i> This study is a retrospective case-control study of patients with a pathology-confirmed diagnosis of PAS managed at a single center over 16 years (2005–2020). All cases were diagnosed during the first or second trimester by ultrasonography and managed by the same multidisciplinary team with delivery within the second trimester. <i>Results</i>: Thirty-four patients with PAS were diagnosed and delivered by the second trimester. Of these, (41.1%) elected for active management and 20 (58.9%) for expectant management but ultimately required delivery prior to 28 weeks’ gestation. Baseline demographics were similar between groups. Intraoperatively, no differences were noted in operative time (191.5 vs. 203 min, <i>p</i> = 0.85), blood loss (2300 vs. 2600 cc, <i>p</i> = 0.85), or incidental cystotomy (1 vs. 7, <i>p</i> = 0.10). Postoperative length of stay was similar (3 vs. 3.5 days, <i>p</i> = 0.28), and ICU admission was not statistically different (6 vs. 12, <i>p</i> = 0.48). <i>Conclusions</i>: This retrospective study suggests that when hysterectomy is planned, there is no difference in maternal outcomes and morbidity with an expectant management with cesarean hysterectomy in the second trimester compared to proactive cesarean hysterectomy. |
| format | Article |
| id | doaj-art-7a229f742be64944aafa2d721a42cc86 |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-7a229f742be64944aafa2d721a42cc862025-01-24T13:40:40ZengMDPI AGMedicina1010-660X1648-91442025-01-0161111310.3390/medicina61010113Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS)Jessian L. Munoz0Rachel Counts1Amanda E. Lacue2Kayla E. Ireland3Patrick S. Ramsey4Kristyn Brandi5Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Division of Fetal Intervention, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USADepartment of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USADepartment of Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ 07103, USADepartment of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USADepartment of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USADepartment of Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ 07103, USA<i>Background and Objectives:</i> Management of second-trimester placenta accreta spectrum (PAS) is currently center-dependent with minimal evidence-based practices. This study aims to analyze outcomes of hysterectomy as second-trimester active management (AM) versus cesarean hysterectomy as expectant management (EM) in cases of PAS with intraoperative and postoperative outcomes. <i>Materials and Methods:</i> This study is a retrospective case-control study of patients with a pathology-confirmed diagnosis of PAS managed at a single center over 16 years (2005–2020). All cases were diagnosed during the first or second trimester by ultrasonography and managed by the same multidisciplinary team with delivery within the second trimester. <i>Results</i>: Thirty-four patients with PAS were diagnosed and delivered by the second trimester. Of these, (41.1%) elected for active management and 20 (58.9%) for expectant management but ultimately required delivery prior to 28 weeks’ gestation. Baseline demographics were similar between groups. Intraoperatively, no differences were noted in operative time (191.5 vs. 203 min, <i>p</i> = 0.85), blood loss (2300 vs. 2600 cc, <i>p</i> = 0.85), or incidental cystotomy (1 vs. 7, <i>p</i> = 0.10). Postoperative length of stay was similar (3 vs. 3.5 days, <i>p</i> = 0.28), and ICU admission was not statistically different (6 vs. 12, <i>p</i> = 0.48). <i>Conclusions</i>: This retrospective study suggests that when hysterectomy is planned, there is no difference in maternal outcomes and morbidity with an expectant management with cesarean hysterectomy in the second trimester compared to proactive cesarean hysterectomy.https://www.mdpi.com/1648-9144/61/1/113abnormal placentationcesarean hysterectomycesarean sectionmaternal morbidityplacenta accreta |
| spellingShingle | Jessian L. Munoz Rachel Counts Amanda E. Lacue Kayla E. Ireland Patrick S. Ramsey Kristyn Brandi Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) Medicina abnormal placentation cesarean hysterectomy cesarean section maternal morbidity placenta accreta |
| title | Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) |
| title_full | Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) |
| title_fullStr | Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) |
| title_full_unstemmed | Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) |
| title_short | Surgical Outcomes and Associated Morbidity of Active and Expectant Management of Second-Trimester Placenta Accreta Spectrum (PAS) |
| title_sort | surgical outcomes and associated morbidity of active and expectant management of second trimester placenta accreta spectrum pas |
| topic | abnormal placentation cesarean hysterectomy cesarean section maternal morbidity placenta accreta |
| url | https://www.mdpi.com/1648-9144/61/1/113 |
| work_keys_str_mv | AT jessianlmunoz surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas AT rachelcounts surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas AT amandaelacue surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas AT kaylaeireland surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas AT patricksramsey surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas AT kristynbrandi surgicaloutcomesandassociatedmorbidityofactiveandexpectantmanagementofsecondtrimesterplacentaaccretaspectrumpas |