PREVALENCE OF ADJACENT ORGAN INJURIES IN CESAREAN HYSTERECTOMY AMONG WOMEN HAVING PLACENTA ACCRETA SPECTRUM DISORDER AT A UNIVERSITY HOSPITAL IN SOUTHERN THAILAND

Problem statement: Placenta accreta spectrum disorder (PAS) refers to the range of pathologic adherence of the placenta. The incidence of PAS is rapidly increasing worldwide. The morbidity of PAS included injuries to adjacent organs, extensive bleeding, disseminated intravascular coagulation (DIC), and even fatalities. Women with PAS are more likely to require cesarean hysterectomy for life-saving. This study is aimed to demonstrate the prevalence of adjacent organ injuries in cesarean hysterectomy at a university hospital in Southern Thailand and to compare the complications between conventional and posterior approached cesarean hysterectomies.

Methods: A retrospective study of all pregnant women with PAS who delivered from 2006 to 2021 was conducted. This study collected data on the patients’ characteristics, clinical outcomes and adjacent organ injuries. A comparison of rates of adjacent organ injuries between women who underwent conventional and posterior approached cesarean hysterectomy was performed using a chi-square test with a p value < 0.05 was considered statistically significant.

Results: A total of 174 pregnant women with PAS were recruited. The overall prevalence of bladder injuries is 16.2%, but the rate of unintentional bladder injuries was only 7.6% (excluding placenta percreta). The estimated blood loss [median (IQR)] during cesarean hysterectomy is about 3000 (1700, 6500) mL, operative times 207 (175, 243) minutes, and the amount of pack red cells transfusion is 3 (2,8) units. Comparison between conventional and posterior approached cesarean hysterectomy, revealed that the posterior approached group had lower estimated blood loss and shorter hospital stays but longer operative times without any negative effects on the fetal outcomes. In terms of injuries to adjacent organs, the posterior approached group had considerably lower rates of urinary bladder injuries (10.1% versus 26.6%, p=0.005) and ureteric injuries (0% versus 4.7%, p=0.049) than the conventional group. Also, the rate of DIC was lower in the posterior approached group (2.3% versus 15.6%, p=0.008).

Conclusions: The prevalence of unintentional adjacent organ injuries among women with PAS in our series was low. Notably, posterior approached cesarean hysterectomy could lower the rates of surrounding organ injuries with less blood loss and blood transfusion and shorten the length of hospital stays.