Wang Lulu, Liu Tianjiao, Yang Yang, Li Yalan, Xiao Li, Li Xin, Wei Sumei
Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue, Chengdu, Sichuan, 610091, China.
Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
BMC Pregnancy Childbirth. 2025 Jan 20;25(1):45. doi: 10.1186/s12884-025-07163-5.
This study aimed to identify risk factors for peripartum hysterectomy among pregnancies complicated by suspected Placenta Accreta Spectrum (PAS) in preoperative obstetric imaging screening.
Data were retrospectively extracted from the Longitudinal Placenta Accreta Spectrum Study (LoPASS), covering pregnancies with PAS from January 2018 to March 2023 at our institute. Patients were divided into Control and Hysterectomy groups based on whether they underwent hysterectomy. Sociodemographic, obstetric, and clinical characteristics were compared between the groups. Multivariate logistic regression analysis was performed on the characteristics with statistical significance to explore risk factors for peripartum hysterectomy.
Among 523 pregnancies with suspected PAS, 20 underwent hysterectomy. The Hysterectomy group had a significantly higher mean age (34.50 ± 5.05 vs. 31.66 ± 4.43 years, p = 0.005) and pre-pregnancy BMI (26.35 ± 3.27 vs. 23.84 ± 3.99, p = 0.006). The Hysterectomy group also had a higher proportion of patients with more than 2 gravidities (100% vs. 61.6%, p = 0.022) and multiple parities (90.0% vs. 39.9%, p < 0.001). Higher percentages of placenta percreta (90.0% vs. 28.2%, p < 0.001), placenta attaching to the anterior uterine wall (57.9% vs. 31.8%, p = 0.033), and higher PAS ultrasonographic scores (11.78 ± 2.68 vs. 6.79 ± 2.77, p < 0.001) were observed in the Hysterectomy group. Perioperative outcomes revealed significantly longer surgical durations (171.90 ± 49.27 vs. 53.46 ± 24.41 min, p < 0.001) and higher rates of preterm birth (100.0% vs. 55.3%, p < 0.001). Intraoperative blood loss was also substantially greater in the Hysterectomy group (2695.00 ± 1241.17 ml vs. 764.31 ± 385.10 ml, p < 0.001). Variables significantly associated with increased peripartum hysterectomy risk included prior cesarean sections (OR = 1.44, p = 0.048), placenta attaching to the anterior uterine wall (OR = 0.73, p = 0.015), placenta completely covering the uterine incision (OR = 1.27, p = 0.035), gestational hypertensive disorder (OR = 1.69, p = 0.042), placenta percreta (OR = 2.31, p = 0.032), and PAS ultrasonographic score higher than 10 (OR = 2.71, p = 0.008).
Most of ultrasound PAS scoring subitems were significantly higher in Hysterectomy group. Cesarean deliveries, placental positioning on the anterior uterine wall, GHD, types of PAS, and ultrasound PAS score higher than 10 predicts peripartum hysterectomy, highlighting the importance of early, timely, and consistent monitoring of the placenta using obstetric ultrasound in pregnancies with suspected PAS.
ChiCTR2100052428, October 26th, 2021.
本研究旨在确定术前产科影像筛查中疑似胎盘植入谱系障碍（PAS）的妊娠患者围产期子宫切除术的危险因素。
回顾性提取纵向胎盘植入谱系障碍研究（LoPASS）的数据，涵盖2018年1月至2023年3月在我院诊断为PAS的妊娠患者。根据是否接受子宫切除术将患者分为对照组和子宫切除术组。比较两组的社会人口统计学、产科和临床特征。对具有统计学意义的特征进行多因素logistic回归分析，以探讨围产期子宫切除术的危险因素。
在523例疑似PAS的妊娠患者中，20例接受了子宫切除术。子宫切除术组的平均年龄（34.50±5.05岁 vs. 31.66±4.43岁，p = 0.005）和孕前体重指数（26.35±3.27 vs. 23.84±3.99，p = 0.006）显著更高。子宫切除术组中多胎次（100% vs. 61.6%，p = 0.022）和多产次（90.0% vs. 39.9%，p < 0.001）的患者比例也更高。子宫切除术组中穿透性胎盘植入（90.0% vs. 28.2%，p < 0.001）、胎盘附着于子宫前壁（57.9% vs. 31.8%，p = 0.033）的百分比更高，PAS超声评分也更高（11.78±2.68 vs. 6.79±2.77，p < 0.001）。围手术期结果显示，手术时间显著更长（171.90±49.27分钟 vs. 53.46±24.41分钟，p < 0.001），早产率更高（100.0% vs. 55.3%，p < 0.001）。子宫切除术组术中出血量也显著更多（2695.00±1241.17毫升 vs. 764.31±385.10毫升，p < 0.001）。与围产期子宫切除术风险增加显著相关的变量包括既往剖宫产（OR = 1.44，p = 0.048）、胎盘附着于子宫前壁（OR = 0.73，p = 0.015）、胎盘完全覆盖子宫切口（OR = 1.27，p = 0.035）、妊娠期高血压疾病（OR = 1.69，p = 0.042）、穿透性胎盘植入（OR = 2.31，p = 0.032）以及PAS超声评分高于10分（OR = 2.71，p = 0.008）。
子宫切除术组的大多数超声PAS评分子项目显著更高。剖宫产、胎盘附着于子宫前壁、妊娠期高血压疾病、PAS类型以及超声PAS评分高于10分可预测围产期子宫切除术，突出了在疑似PAS的妊娠中使用产科超声对胎盘进行早期、及时和持续监测的重要性。
ChiCTR2100052428，2021年10月26日。
