Main Findings
In the current study, data from a multicentre study was used to compare uterus preserving procedure to caesarean hysterectomy in women with PAS. After adjusting for potential confounders, uterus preserving procedures did not seem to increase risk of perioperative massive blood loss. Our results also showed that increased BMI, more advanced gestational age at diagnosis of PAS, use of interventional radiology, centrally located placenta over the internal os, diffuse placental invasion, parametrial and bladder invasion, and intrauterine foetal death were risk factors for massive blood loss. On the other side, higher preoperative haemoglobin, and uterine incision away from the placenta were both protective against significant bleeding. Incidence of complications between the two approaches were comparable with higher incidence in unintentional cystotomy in women undergoing caesarean hysterectomy.