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Poster Session 4

Category: Operative Obstetrics

Poster Session 4

(1009) Outcomes of non-placenta accreta spectrum peripartum hysterectomy following implementation of a placenta accreta spectrum program

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Alexandra D. Forrest, MD (she/her/hers)

Maternal-Fetal Medicine Fellow
Johns Hopkins University
Baltimore, Maryland, United States

Coauthor(s)

AF

Amanda Finney

Johns Hopkins University
Baltimore, Maryland, United States
LP

Laura Prichett, PhD

Johns Hopkins University
Baltimore, Maryland, United States
DE

Debra Eluobaju, MD, MPH

Johns Hopkins University
Baltimore, Maryland, United States
KM

Kristin Martin, MD

Johns Hopkins University
Baltimore, Maryland, United States
Arthur Jason Vaught, MD

Johns Hopkins University
Baltimore, Maryland, United States

Objective:
Peripartum hysterectomy carries high risks of maternal morbidity and mortality. While hysterectomies for placenta accreta spectrum (PAS) are often planned and performed by multidisciplinary teams, those for non-PAS indications typically occur emergently and are less likely to have multidisciplinary approaches. Our institution launched a dedicated PAS program in 2018. We hypothesized that program-related advances would improve non-PAS peripartum hysterectomy outcomes.

Study Design:
We conducted a single-center retrospective cohort study of all non-PAS peripartum hysterectomies from January 2013 to December 2024. Cases were grouped as pre- (2013–2017) and post- (2018–2024) PAS program implementation. We compared demographic and clinical outcomes before and after implementation using chi-square or Fisher’s exact tests and t-tests or Mann-Whitney U tests, as appropriate.

Results:
79 non-PAS peripartum hysterectomies were performed: 42 pre- and 37 post-program. Baseline demographics were similar except patients in the post-program group had higher parity (median 3 vs 2, p=0.04), lower prevalence of hypertension (8% vs 26%, p=0.04), and were more likely to have an MFM as primary surgeon (97% vs 33%, p< 0.01). Post-program patients also required fewer pRBC units (3 vs 6, p< 0.01), fewer total transfused units (6 vs 12, p=0.02), had decreased ICU admission (49% vs 71%, p=0.04), and fewer intraoperative consults (41% vs 76%, p< 0.01). 2 maternal deaths and 3 cardiac arrests occurred pre-program and none occurred post-program. In a subgroup analysis limited to hysterectomies for postpartum hemorrhage, ICU admission remained significantly lower post-program (38% vs 75%, p=0.01), though transfusion metrics were similar.

Conclusion:
Implementation of a PAS program was associated with improved outcomes for peripartum hysterectomy performed for non-PAS indications. These findings suggest that PAS program development may reduce adverse outcomes, ICU admission, and resource utilization in other peripartum hysterectomies.