(1097) Maternal Morbidity Among Pregnant Women With Placenta Accreta Spectrum Treated Conservatively versus Non-Conservatively

Placenta accreta spectrum (PAS) is a life-threatening condition that is increasing in incidence along with cesarean rates worldwide. The current standard of management of PAS is cesarean hysterectomy. Few studies have compared maternal outcomes after cesarean hysterectomy versus a uterus-preserving approach. Thus, this study aims to compare maternal morbidity for women with PAS who undergo non-conservative versus conservative management.

Study Design:

This is a retrospective cohort study using delivery hospitalization records from the 2021-2022 National Inpatient Sample. Pregnant individuals aged 18 and older who delivered at ≥ 20 weeks’ gestation and had a documented diagnosis of PAS were included. Baseline characteristics, exposures, and outcomes were identified using ICD-10 codes. Weighted survey methods accounting for the complex sampling design were applied. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using logistic regression. A sensitivity analysis was performed in a restricted cohort of individuals diagnosed with various PAS subtypes.

Results:

From this representative sample of 20% of all US hospitals, a weighted sample of delivery hospitalizations from 4,433 women with PAS and 33,108,352 women without PAS were obtained. Of those with PAS who delivered during admission, 813 underwent cesarean hysterectomy and 960 were managed conservatively. Women with PAS who were managed conservatively had a 67% reduction in risk of developing at least one morbidity during their hospitalization (aOR 0.33, 95% CI: 0.25-0.43). Conservative management was associated with less shock (OR 0.19, 95% CI: 0.10-0.37), disseminated intravascular coagulation (OR 0.34, 95% CI: 0.21-0.55), and blood transfusions (OR 0.33, 95% CI: 0.26-0.42). This association remained statistically significant with a restricted study population limited to increta, percreta, and accreta cases who also had a placenta previa (aOR 0.40, 95% CI: 0.27, 0.60).

Conclusion:

Conservative management of PAS is associated with significantly lower risk of maternal morbidity.