Introduction
Placenta accreta spectrum (PAS) refers to a spectrum of pathological
placental adherence disorders, in which trophoblastic growth invades the
deeper tissue of the uterine wall to various degrees (1). PAS has drawn
considerable attention in the current century since the incidence of PAS
has increased significantly in response to the rising trend of caesarean
deliveries (CD) (2). The incidence of PAS rose from 1 in 4,000
deliveries in the 70s of the last century to 1 in 533 to 1 in 730
deliveries in the last decade (3). PAS is associated with significant
maternal morbidity including massive obstetric haemorrhage,
coagulopathy, ICU admission, mechanical ventilation, infection, and
prolonged hospitalization. Maternal mortality reaches 30% in some
reports (4).
Caesarean hysterectomy is, by far, the most widely accepted management
of PAS since it promotes controlled surgical circumstances and precludes
massive bleeding from placental disruption. Caesarean hysterectomy is
endorsed by the American College of Obstetricians and Gynecologists
(ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG)
as a primary approach in women with PAS (5, 6). Nevertheless, the
practice of uterine preservation, which comprise several procedures that
aim at stopping uterine bleeding without removing the uterus, is widely
adopted worldwide (7). This practice is driven by high motivation of
many women to preserve their future fertility, which has led to
increasing experience of performing these procedures (8). However,
evidence on efficacy and safety of most uterus preserving procedures are
limited due to paucity of consistent studies and limited sample size.
These factors have resulted in a wide gap between evidence-based
recommendations and current practice regarding PAS management in many
countries of the world.
Placenta accreta spectrum international database (PAS-ID) is a large
international multi-center study of women with confirmed diagnosis of
PAS. The objective of this study is to compare perioperative massive
blood loss between women who underwent uterus preserving procedures and
caesarean hysterectomy. In addition, the study aims at identifying
antenatal and intrapartum risk factors associated with massive bleeding
in women with PAS.