Prediction of success of uterus-preserving management in women with

Abstract

Objective To create a model for prediction of success of uterine-preserving procedures in women with placenta accreta spectrum (PAS).

Methods PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation.

Results Out of 797 women with PAS, 587 were eligible. Uterus-preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001-3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05-0.43), type of CS incision (aOR 0.04, 95% CI 0.01-0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00-6.16), accreta type (aOR 3.76, 95% CI 1.13-12.53), incising away from placenta (aOR 5.09, 95% CI 1.52-16.97), and uterine resection (aOR 102.57, 95% CI 3.97-2652.74).

Conclusion The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

C1 [Shazly, Sherif A.; Salah, Mohamed A.; Abd Elazeem, Hossam Aldein S.; Saad, Mahmoud M.] Assiut Univ, Dept Obstet & Gynecol, Assiut, Egypt.

[Hortu, Ismet; Ergenoglu, Ahmet M.; Yeniel, Ahmet O.; Sagol, Sermet; Itil, Ismail M.] Ege Univ, Dept Obstet & Gynecol, Sch Med, Izmir, Turkey.

[Shih, Jin-Chung; Kang, Jessica; Huang, Kuan-Ying] Natl Taiwan Univ, Dept Obstet & Gynecol, Coll Med, Taipei, Taiwan.

[Melekoglu, Rauf; Yilmaz, Ercan] Inonu Univ, Dept Obstet & Gynecol, Malatya, Turkey.

[Fan, Shangrong; Liang, Yiheng] Peking Univ, Dept Obstet & Gynecol, Shenzhen Hosp, Shenzhen, Guangdong, Peoples R China.

[ul Ain Ahmed, Farhat; Aziz, Hijab; Akhter, Tayyiba; Ambreen, Afshan] Fatima Mem Hosp, Dept Obstet & Gynecol, Punjab, Pakistan.

[Karaman, Erbil; Ates, Cagri] Yuzuncu Yil Univ, Dept Obstet & Gynecol, Van, Turkey.

[Fatkullin, Ildar; Khasanov, Albir; Fatkullina, Larisa; Akhmadeev, Nariman] Kazan State Med Univ, Dept Obstet & Gynecol, Kazan, Republic Of Tat, Russia.

[Pinto, Pedro V.; Machado, Ana Paula; Montenegro, Nuno] Ctr Hosp Sao Joao, Serv Ginecol & Obstet, Porto, Portugal.

[Irianti, Setyorini; Effendi, Jusuf S.; Suardi, Dodi; Pramatirta, Ahmad Y.; Aziz, Muhamad A.; Siddiq, Amilia] Univ Padjadjaran Bandung, Taskforce Placenta Accreta Spectrum, Bandung, West Jawa, Indonesia.

[Tochie, Joel Noutakdie; Ofakem, Ingrid; Dohbit, Julius Sama] Univ Yaounde I, Fac Med & Biomed Sci, Dept Obstet & Gynecol, Yaounde, Cameroon.

[Abdelbadie, Amr S.; Fahmy, Mohamed S.; Anan, Mohamed A.] Aswan Univ Hosp, Dept Obstet & Gynecol, Aswan, Egypt.

[Karaman, Yasemin] Lokman Hekim Hayat Hosp, Dept Obstet & Gynecol, Van, Turkey.

[Vatanina, Adelina] Minist Healthcare Republ Tatarstan, Republ Clin Hosp, Kazan, Tatarstan, Russia.