Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies
Abstract Objective This study aimed to identify risk factors for peripartum hysterectomy among pregnancies complicated by suspected Placenta Accreta Spectrum (PAS) in preoperative obstetric imaging screening. Methods Data were retrospectively extracted from the Longitudinal Placenta Accreta Spectrum...
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BMC
2025-01-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07163-5 |
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| author | Lulu Wang Tianjiao Liu Yang Yang Yalan Li Li Xiao Xin Li Sumei Wei |
| author_facet | Lulu Wang Tianjiao Liu Yang Yang Yalan Li Li Xiao Xin Li Sumei Wei |
| author_sort | Lulu Wang |
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| description | Abstract Objective This study aimed to identify risk factors for peripartum hysterectomy among pregnancies complicated by suspected Placenta Accreta Spectrum (PAS) in preoperative obstetric imaging screening. Methods 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. Results 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). Conclusion 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. Trial registration ChiCTR2100052428, October 26th, 2021. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-c8a2c3343f9e497cad666084c747c0d42025-01-26T12:57:16ZengBMCBMC Pregnancy and Childbirth1471-23932025-01-0125111310.1186/s12884-025-07163-5Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnanciesLulu Wang0Tianjiao Liu1Yang Yang2Yalan Li3Li Xiao4Xin Li5Sumei Wei6Department of Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of ChinaDepartment of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of ChinaDepartment of Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of ChinaPsychosomatic Medical Center, The Fourth People’s Hospital of ChengduMedical Administrative Department, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of ChinaDepartment of Gynecology and Obstetrics, West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of ChinaAbstract Objective This study aimed to identify risk factors for peripartum hysterectomy among pregnancies complicated by suspected Placenta Accreta Spectrum (PAS) in preoperative obstetric imaging screening. Methods 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. Results 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). Conclusion 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. Trial registration ChiCTR2100052428, October 26th, 2021.https://doi.org/10.1186/s12884-025-07163-5Risk factorsHysterectomyPlacenta accreta spectrumCesarean sectionsPeripartum hemorrhagic morbidity |
| spellingShingle | Lulu Wang Tianjiao Liu Yang Yang Yalan Li Li Xiao Xin Li Sumei Wei Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies BMC Pregnancy and Childbirth Risk factors Hysterectomy Placenta accreta spectrum Cesarean sections Peripartum hemorrhagic morbidity |
| title | Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies |
| title_full | Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies |
| title_fullStr | Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies |
| title_full_unstemmed | Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies |
| title_short | Preoperative ultrasound risk factors for peripartum hysterectomy among PAS suspected pregnancies |
| title_sort | preoperative ultrasound risk factors for peripartum hysterectomy among pas suspected pregnancies |
| topic | Risk factors Hysterectomy Placenta accreta spectrum Cesarean sections Peripartum hemorrhagic morbidity |
| url | https://doi.org/10.1186/s12884-025-07163-5 |
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