Munoz Jessian L, Counts Rachel, Lacue Amanda E, Ireland Kayla E, Ramsey Patrick S, Brandi Kristyn
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Division of Fetal Intervention, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USA.
Medicina (Kaunas). 2025 Jan 14;61(1):113. doi: 10.3390/medicina61010113.
Management of second-trimester placenta accreta spectrum (PAS) is currently center-dependent with minimal evidence-based practices. This study aims to analyze outcomes of hysterectomy as second-trimester active management (AM) versus cesarean hysterectomy as expectant management (EM) in cases of PAS with intraoperative and postoperative outcomes. This study is a retrospective case-control study of patients with a pathology-confirmed diagnosis of PAS managed at a single center over 16 years (2005-2020). All cases were diagnosed during the first or second trimester by ultrasonography and managed by the same multidisciplinary team with delivery within the second trimester. : Thirty-four patients with PAS were diagnosed and delivered by the second trimester. Of these, (41.1%) elected for active management and 20 (58.9%) for expectant management but ultimately required delivery prior to 28 weeks' gestation. Baseline demographics were similar between groups. Intraoperatively, no differences were noted in operative time (191.5 vs. 203 min, = 0.85), blood loss (2300 vs. 2600 cc, = 0.85), or incidental cystotomy (1 vs. 7, = 0.10). Postoperative length of stay was similar (3 vs. 3.5 days, = 0.28), and ICU admission was not statistically different (6 vs. 12, = 0.48). : This retrospective study suggests that when hysterectomy is planned, there is no difference in maternal outcomes and morbidity with an expectant management with cesarean hysterectomy in the second trimester compared to proactive cesarean hysterectomy.
孕中期胎盘植入谱系疾病（PAS）的管理目前依赖于各个中心，基于循证实践的做法很少。本研究旨在分析在PAS病例中，子宫切除术作为孕中期积极管理（AM）与剖宫产子宫切除术作为期待管理（EM）的术中及术后结果。本研究是一项回顾性病例对照研究，研究对象为在16年（2005 - 2020年）期间于单一中心接受病理确诊为PAS的患者。所有病例均在孕早期或孕中期通过超声诊断，并由同一多学科团队管理，在孕中期分娩。34例PAS患者在孕中期被诊断并分娩。其中，14例（41.1%）选择积极管理，20例（58.9%）选择期待管理，但最终均在妊娠28周前分娩。两组间基线人口统计学特征相似。术中，手术时间（191.5 vs. 203分钟，P = 0.85）、失血量（2300 vs. 2600毫升，P = 0.85）或意外膀胱切开术（1 vs. 7，P = 0.10）均无差异。术后住院时间相似（3 vs. 3.5天，P = 0.28），重症监护病房（ICU）入住率在统计学上无差异（6 vs. 12，P = 0.48）。这项回顾性研究表明，当计划进行子宫切除术时，与孕中期积极的剖宫产子宫切除术相比，期待管理下的剖宫产子宫切除术在孕产妇结局和发病率方面并无差异。
