Erin T. Welsh, MA , 2025-05-16 21:18:00
Key takeaways:
- For most women with placenta accreta spectrum disorder, leaving the placenta in situ did not lead to serious complications.
- This may be an alternative to cesarean hysterectomy for some women.
MINNEAPOLIS — In a small study, most women with placenta accreta spectrum disorder who had their placenta left in situ did not experience infections or bleeding requiring a hysterectomy.
The findings were presented at the ACOG Annual Clinical & Scientific Meeting and published in Obstetrics & Gynecology.
In a small study, most women with placenta accreta spectrum disorder who had their placenta left in situ did not experience infections or bleeding requiring a hysterectomy. Image: Adobe Stock
According to Farah Hassan Amro, MD, chief of clinical practice at ACOG and an assistant professor in the department of OB/GYN and reproductive sciences at the University of Texas, Health Science Center at Houston, the incidence of placenta accreta spectrum (PAS) disorder is increasing, primarily due to higher cesarean delivery rates.
Currently, ACOG recommends cesarean hysterectomy to manage PAS, with all other approaches considered investigational or experimental, Amro noted.
“There have been several other approaches that have been proposed for managing PAS. Some of these approaches have been proposed internationally. They include removing the placenta with oversewing the placental bed as well as a receptive reconstructive technique, which involves removing the placenta as well as the uterine myometrium,” Amro said during the presentation. “There are also some approaches that have been proposed nationally. One of those approaches is performing a delayed hysterectomy, which involves performing a cesarean section, leaving the placenta in situ, and then performing the hysterectomy 4 to 6 weeks postpartum.”
Amro and colleagues conducted a single-center retrospective cohort study from January 2015 to October 2024. Their analysis included 180 women with PAS, 50 of whom were planned to be managed by leaving the placenta in situ. The researchers evaluated maternal outcomes after leaving the placenta in situ, including infection risk, significant bleeding resulting in hysterectomy, transfusion rates and serious maternal morbidity.
Overall, 43 women were managed by leaving the placenta in situ and 14% underwent cesarean hysterectomy due to antepartum or intraoperative hemorrhage. Of those who had their placenta left in situ (mean age, 34 years), 12% had bleeding requiring a hysterectomy and 9% had endometriosis.
Of 29 women who planned for uterine preservation, 45% were successful, with a median time of 17 weeks to expulsion or resorption, and 55% underwent interval hysterectomy.
Compared with women who ultimately underwent an interval hysterectomy, those who had successful uterine preservation had less blood loss (median estimated total blood loss, 700 vs. 1,950 mL; P < .01), lower transfusion rates (31% vs. 73%; P < .01) and fewer transfusions exceeding four units (8% vs. 47%; P = .01). Five women had subsequent pregnancies without placenta previa or PAS.
The researchers said there were no cases of venous thromboembolism or deaths.
“Leaving the placenta in situ may be appropriate to offer as an alternative to cesarean hysterectomy in select cases,” Amro said. “However, our data need to be interpreted with caution given the small sample size, which could potentially preclude detection of rare but potentially serious complications.”
