Peripartum Hysterectomy due to Placenta Accreta Spectrum Disorders - Improved Maternal and Neonatal Morbidity after Diagnostic Ultrasound and Multidisciplinary Care

Berglind Arnadottir1, Sahar Salehi2, Johan Nordstrom3 and Ylva Vladic Stjernholm1*

1Department of Women's and Children's Health, Obstetric Unit
2Department of Pelvic Cancer, Theme Cancer
3Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital and Karolinska Institute, Sweden

^*Correspondance to: Ylva Vladic Stjernholm 

 PDF  Full Text DOI: 10.25107/2474-1647.2748

Abstract

Introduction: The increasing Cesarean Section (CS) rate worldwide is followed by increased maternal morbidity due to Placenta Accreta Spectrum (PAS) disorders. The objective was to evaluate the rate of CS with Peripartum Hysterectomy (PPHE) due to advanced PAS disorders during the years 2008-18. Furthermore, we compared the rates of antenatal detection and planned surgery, as well as maternal and neonatal morbidity. between the two periods 2008-15 and 2016-18, before and after the introduction of diagnostic ultrasound in women at increased risk of PAS disorders at 2nd trimester ultrasound and multidisciplinary care in cases of advanced PAS disorders in need of CS with PPHE. Material and Methods: A retrospective cohort study at a tertiary university hospital in Sweden. All women (n=17) in 2008-15 and (n=19) in 2016-18 who underwent CS with PPHE due to advanced PAS disorders were included. Results: The rate of CS with PPHE due to advanced PAS disorders increased from 0.7 to 2.2 per 10,000 deliveries during 2008-18. Antenatal detection increased from 70% to 95% (p=0.05) and planned surgery from 53% to 84% (p=0.02) between the two periods 2008-15 and 2016-18. Perioperative blood loss decreased from 6-2 L (p=0.01), erythrocyte transfusion from 12-3 U (p=0.007), and composite maternal morbidity from 88% to 12% (p=0.001). The rate of newborns with birth weight <2500 g decreased from 58% to 21% (p=0.02), Apgar score <7 at 5 min from 58% to 31% (p=0.05) and umbilical artery base excess BE(a) less than -10 mmol/L from 16% to 0% (p=0.05). Conclusion: The rate of CS with PPHE due to advanced PAS disorders increased three-fold. The introduction of diagnostic ultrasound and multidisciplinary care was followed by increased rates of antenatal detection and planned surgery, and evident improvements in maternal and neonatal morbidity. We suggest diagnostic ultrasound in women at increased risk of PAS disorders and centralized high-risk obstetrics with multidisciplinary care in cases of advanced PAS disorders.

Keywords

Cesarean; Hysterectomy; Placenta Accreta; Ultrasound

Cite the article

Arnadottir B, Salehi S, Nordstrom J, Stjernholm YV. Peripartum Hysterectomy due to Placenta Accreta Spectrum Disorders - Improved Maternal and Neonatal Morbidity after Diagnostic Ultrasound and Multidisciplinary Care. Clin Surg. 2020; 5: 2748..