Abstract | BACKGROUND: OBJECTIVE: STUDY DESIGN: From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. RESULTS: Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19-0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. CONCLUSION:
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Authors | Loïc Sentilhes, Aurélien Seco, Elie Azria, Gaël Beucher, Marie-Pierre Bonnet, Bernard Branger, Lionel Carbillon, Coralie Chiesa, Catherine Crenn-Hebert, Michel Dreyfus, Corinne Dupont, Jeanne Fresson, Cyril Huissoud, Bruno Langer, Olivier Morel, Sophie Patrier, Franck Perrotin, Pierre Raynal, Patrick Rozenberg, René-Charles Rudigoz, Francoise Vendittelli, Norbert Winer, Catherine Deneux-Tharaux, Gilles Kayem, PACCRETA Study Group |
Journal | American journal of obstetrics and gynecology
(Am J Obstet Gynecol)
Vol. 226
Issue 6
Pg. 839.e1-839.e24
(06 2022)
ISSN: 1097-6868 [Electronic] United States |
PMID | 34914894
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2021 Elsevier Inc. All rights reserved. |
Topics |
- Cesarean Section
- Conservative Treatment
- Female
- Humans
- Hysterectomy
- Placenta Accreta
(epidemiology, surgery)
- Pregnancy
- Prospective Studies
- Retrospective Studies
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