Placenta Previa Accreta Spectrum During Labor: Can it lead to Hysterectomy?

 Placenta Previa Accreta Spectrum During Labor Can Lead to Hysterectomy.

Abstract

A B S T R A C T

Background: Placenta Previa Accreta Spectrum (PAS) is a serious obstetric condition that causes severe hemorrhage and an increased risk of hysterectomy. Early identification of risk factors and appropriate management strategies are essential to improve maternal outcomes. Aims: To evaluate the incidence and risk factors associated with hysterectomy among patients with placenta previa accreta spectrum, assess maternal outcomes, and identify clinical management strategies that may reduce the need for hysterectomy. Methods: A retrospective cohort study was conducted at Elsaid Hospital. Medical records of 105 women diagnosed with PAS (2017 and 2024) were reviewed. Data collected included age, parity, previous cesarean sections, antepartum hemorrhage, comorbidities, hemoglobin levels, blood transfusion requirements, surgical interventions, and maternal outcomes. Statistical analysis was performed using descriptive and inferential methods, with a significance level of p < 0.05. Results: the overall incidence of PAS was 0.53 %. The incidence progressively increased over time. In 2017, PAS incidence was 0.39%, which then progressed to reach the highest incidence (1.06%) in 2024. The mean age of participants was 33.5 ± 5.1 years. The cohort had a high prevalence of multiple cesarean deliveries, with 62.5% having three or more previous cesarean sections. Antepartum hemorrhage and anemia were reported in 44.8% of cases each. Placenta previa accreta was associated with maternal morbidity, including increased blood transfusion requirements and a heightened risk of hysterectomy, particularly among women with multiple previous cesarean deliveries and severe obstetric complications. Maternal mortality was 0.95%. Conclusion: PAS remains a major cause of maternal morbidity and mortality constitutes a primary indication for intrapartum hysterectomy. Previous cesarean sections, antepartum hemorrhage, and anemia are important risk factors associated with adverse maternal outcomes. Resorting to hysterectomy in cases of PAS should not be regarded as an inevitable sequela; early diagnosis and multidisciplinary management are essential to reduce complications and improve outcomes.