Maternal Outcomes of Hysterectomy and Conservative Surgery in Placenta Accreta

Background: Abnormal invasive placentation or placenta accreta spectrum (PAS) has been an emerging disease in developing countries where cesarean sections are routinely performed. Here we report our own data to contribute to the variety of techniques for reducing morbidity and mortality in placenta accreta cases across the world. Objective: This study aims to analyze maternal outcomes, associated risk factors, and our surgery technique in placenta accreta patients treated at Haji Adam Malik Hospital, Indonesia. Methods: We conducted a retrospective study in a tertiary hospital in North Sumatra, with a total of 70 patients suspected to have placenta accreta between January 2017 and June 2019. We compared age, gestational age, previous cesarean section, history of antepartum bleeding, placenta accreta index score, and intraoperative data, including the type of anesthesia, estimated blood loss, the need for transfusion, duration of surgery, complication, and management of the patient. Results: From 70 suspected cases of placenta accreta, 52 (74.2%) patients were diagnosed with placenta accreta and 18 (25.7%) were diagnosed with placenta previa (non-accreta) during surgery. Of the 52 placenta accreta patients, hysterectomy was performed in 42 and the other 10 were treated with conservative surgical procedures. Morbidities such as bladder injury (5.8%; 3/42) and iliac vein injury (4.8%; 2/42) were reported during hysterectomy. There were two (4.8%) mortalities reported. Conclusion: PAS is an emerging disease with high mortality and morbidity rates, which requires comprehensive management including referral to a multidisciplinary care team for diagnosis and management.