Leaving Placenta In Situ Safe Alternative to Cesarean Hysterectomy in placenta accreta spectrum disorder: Study

In the study, 50 patients with antenatal diagnoses of PAS were planned for conservative management by leaving the placenta in situ. Of these, 43 (86%) were successfully managed without immediate hysterectomy. Among these 43 patients, 5 (12%) eventually required hysterectomy due to bleeding, and 4 (9%) developed endometritis. Notably, there were no cases of venous thromboembolism or maternal death reported. Furthermore, among the 29 patients who were planned for uterine preservation, 13 (45%) achieved successful uterine preservation, with a median time to placental resorption or expulsion of 17 weeks.

These patients experienced lower median estimated blood loss (700 mL vs. 1,950 mL) and reduced blood transfusion rates compared to those who ultimately underwent hysterectomy. 

These findings align with previous research indicating that conservative management of PAS can be effective in select cases. For instance, a systematic review and meta-analysis found that conservative management was associated with lower estimated blood loss, fewer transfusions, and decreased risks of bladder injury and ICU admission compared to cesarean hysterectomy. However, it also noted an increased risk for endometritis and readmission. 

In conclusion, leaving the placenta in situ may be a viable alternative to cesarean hysterectomy for women with PAS who desire uterine preservation. This approach requires careful patient selection, thorough counseling about potential risks and benefits, and close postpartum monitoring to manage any complications that may arise.