INTRODUCTION:
To compare the outcomes of women with placental percreta (PP) who underwent immediate hysterectomy (IMM) to those with conservative management with delayed, interval hysterectomy (INT).
METHODS:
A retrospective review with a cohort between 2011 and 2017 of cases with abnormal placentation (AP) diagnosed with US/MRI. Patients were delivered with a massive transfusion protocol and a multidisciplinary accreta team. Estimated blood loss (EBL), length of stay (LOS), and other complications were compared using SAS.
RESULTS:
Of our cohort of 93 patients with AP, 20 (22%) had pathologically confirmed PP. Eleven (55%) women underwent IMM; 9 (45%) underwent INT. The median gestational age at delivery was 35 versus 34 for IMM versus INT (P=.97). The IMM group was more likely to have an emergent procedure compared to the INT group (27.3% versus 11.1%; P=.59). Median EBL for IMM was 2,800 mL (range 1,200–25,000 mL) versus 1,000 mL (range 300–3,700 mL) for INT group (P<.01). Median LOS in IMM versus INT was 15 versus 7 days (P=.34). There was a trend towards a higher rate of transfusion (100% versus 44%; P<.01) and cystotomy (45% versus 11%; P=.16) for IMM versus INT. The rate infection (0% versus 11%; P=.45) were similar for IMM compared to INT.
CONCLUSION:
Compared to IMM, conservative management with INT is associated with decreased EBL and a trend towards lower rates of transfusion and cystotomy than IMM in PP. There was a trend towards increased rate of infection with INT.
