Uterus Preservation Versus Caesarean Hysterectomy in Management of Placenta Accreta Spectrum: A Multicentre International Study
Diğer yayınlar > Diğer · 2021
Yazarlar: Sherif Shazly, İsmet HORTU, Jin-chung Shih, Rauf Melekoglu, Shangrong Fan, Farhatulain ahmed, Erbil Karaman, Ildar Fatkullin, Pedro Pinto, Setyorini Irianti, Joel Tochie, Amr Abdelbadie, Mohamed Ashraf, Ahmad Radwan, Esraa Sayed, Gena Elassall, Esraa Hosny, Shimaa Ali, Ayman Dawood, A. Mete Ergenoglu, Ahmet Özgür YENİEL, Sermet SAĞOL, İsmail Mete İTİL, Jessica Kang, KUAN-YING HUANG, Ercan Yilmaz, Yiheng Liang, Hijab Aziz, Tayyiba Akhter, Afshan Ambreen, Çağrı Ateş, Yasemin Karaman, Albir Khasanov, Larisa Fatkullina, Nariman Akhmadeev, Adelina Vatanina, Ana Machado, Nuno Montenegro, Jusuf Effendi, Dodi Suardi, Ahmad Pramatirta, Muhamad Aziz, Amilia Siddiq, Ingrid Ofakem, Julius Dohbit, Mohamed Fahmy, Mohamed Anan
Diğer, Uluslararası, 2021,
Özet
Objective: To compare peripartum outcomes of uterus preserving procedures to caesarean hysterectomy in women with placenta accreta spectrum (PAS), and to identify risk factors associated with adverse maternal outcomes. Design: Retrospective study (ClinicalTrials.gov identifier: NCT04384510) Setting:11 tertiary centres from 9 countries Population or Sample: women with of PAS who were managed in participating centres between January 1st, 2010 and December 31st, 2019. Women who had confirmed diagnosis with PAS with adequate documentation and follow-up, were considered eligible. Main Outcome Measures: Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Results: Out of 797 women, 727 were eligible for the study. Five hundred ninety-two (81.43%) women were managed by uterus preserving procedures versus 135 (18.56%) who underwent caesarean hysterectomy. After adjustment for significant or close-to-significance variables, type of management was not associated with higher risk of massive blood loss (aOR 1.71, 95% CI 0.78 - 3.81). Other factors that were significantly associated with higher risk of massive PAS-associated blood loss included body mass index, preoperative haemoglobin, centrally located placenta, diffuse placental invasion, parametrial invasion, and intrauterine foetal death. Conclusions: In the presence of sufficient experience, uterus preserving procedures may not be associated with higher risk of massive blood loss compared to caesarean hysterectomy. Funding: none