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.