Pregnancies with a preoperative placenta accreta spectrum ultrasonographic score higher than 10 had an increased risk of peripartum hysterectomy, with an odds ratio of 2.71, according to a recent study. 

Researchers conducted a retrospective cohort study to identify risk factors for peripartum hysterectomy in pregnancies complicated by suspected placenta accreta spectrum (PAS) using preoperative ultrasound assessment. Data were obtained from the Longitudinal Placenta Accreta Spectrum Study and included pregnancies diagnosed with PAS between January 2018 and March 2023.

Patients were categorized into a control group and a hysterectomy group based on surgical outcomes. The researchers analyzed sociodemographic, obstetric, and clinical characteristics, and performed multivariate logistic regression to identify independent predictors of peripartum hysterectomy.

Published in BMC Pregnancy and Childbirth, the study included 523 pregnancies with suspected PAS, of which 20 (3.8%) required peripartum hysterectomy. Patients in the hysterectomy group were older (34.50 years vs. 31.66 years) and had a higher pre-pregnancy BMI (26.35 vs. 23.84). Gravidity of 3 or more was observed in all patients undergoing hysterectomy (100% vs. 61.6%), and multiparity was more common in this group (90% vs. 39.9%). The prevalence of placenta percreta was significantly greater in the hysterectomy group (90% vs. 28.2%), as was anterior uterine wall attachment (57.9% vs. 31.8%). The PAS ultrasonographic score was notably higher among patients who underwent hysterectomy (11.78 vs. 6.79).

Perioperative outcomes demonstrated significantly longer surgical durations in the hysterectomy group (171.90 vs. 53.46 min), higher rates of preterm birth (100% vs. 55.3%) and increased intraoperative blood loss (2,695 ml vs. 764.31 ml), according to Lulu Wang of the Department of Obstetrics at the University of Electronic Science and Technology of China, and colleagues.

Multivariate logistic regression identified several independent risk factors for peripartum hysterectomy, including previous cesarean sections (OR = 1.44), placenta completely covering the uterine incision (OR = 1.27), anterior uterine wall attachment (OR = 0.73), gestational hypertensive disorder (OR = 1.69), placenta percreta (OR = 2.31), and PAS ultrasonographic score higher than 10 (OR = 2.71).

PAS ultrasound score exceeding 10, anterior placental attachment, and placenta percreta are associated with an increased risk of peripartum hysterectomy, according to findings. These results indicate that preoperative ultrasonographic assessment serves as a predictive tool for stratifying risk in pregnancies complicated by PAS, rather than providing a definitive diagnosis.

"Our findings emphasize the critical importance of early, timely, and consistent monitoring of the placenta using medical imaging, especially in cases with risks or signs of PAS," noted Wang. However, "a multicenter prospective study with a randomized controlled trial (RCT) design is warranted to provide more solid clinical evidence for facilitating the prenatal examination and preliminary diagnosis of PAS."

Full disclosures can be found in the published study.