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Trends, characteristics, and outcomes of conservative management for placenta percreta

  • Obstetrics and Gynecology
  • Published:
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Abstract

Purpose

To examine trends, characteristics, and outcomes of women with placenta percreta who had conservative management at cesarean delivery (CD) without hysterectomy.

Methods

This is a retrospective cohort study querying the National Inpatient Sample. The Study population was comprised of women with diagnosis of placenta percreta who underwent CD from 10/2015–12/2018. Characteristics and surgical outcome of women who had hysterectomy at time of CD were compared to those who did not (conservative management) in multivariable analysis.

Results

A total of 1055 cases were examined, of which 790 (74.9%) received hysterectomy at CD and the remaining 265 (25.1%) had conservative management without hysterectomy. During the study period, performance of hysterectomy at CD increased from 71.4% to 93.8% (P < 0.001). In multivariable analysis, more recent cases of CD for placenta percreta were less likely to have conservative management [adjusted-odds ratio (aOR) per year-quarter 0.93, 95% confidence interval (CI) 0.89–0.97]. In contrast, hospitals with small-medium bed capacity (aOR 1.72, 95% CI 1.18–2.51), non-urban teaching setting (aOR 1.76, 95% CI 1.14–2.70), and located in the Midwest (aOR 2.55, 95% CI 1.56–4.17) were more likely to offer conservative management at CD. Later gestational age was also associated with a higher likelihood of conservative management (median gestational age, 36 versus 34 weeks, P < 0.001). Women in the conservative management group experienced lower measured surgical morbidity during the admission compared to those in the cesarean hysterectomy group (47.2% versus 75.9%, aOR 0.35, 95% CI 0.26–0.48).

Conclusion

The clinical practice for placenta percreta appears to be shifting to upfront hysterectomy at the time of CD.

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Data availability statement

The data on which this study is based are publicly available upon request at Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. https://www.hcup-us.ahrq.gov/nisoverview.jsp

Code availability

Described in the method section.

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Funding

Ensign Endowment for Gynecologic Cancer Research (Ko.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Author notes

  1. Ariane C. Youssefzadeh, Shinya Matsuzaki and Koji Matsuo contributed equally to this study.

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA

    Ariane C. Youssefzadeh, Shinya Matsuzaki, Rachel S. Mandelbaum, Rauvynne N. Sangara, Liat Bainvoll & Koji Matsuo

  2. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Rachel S. Mandelbaum

  3. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Liat Bainvoll

  4. Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Kazuhide Matsushima

  5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Joseph G. Ouzounian

  6. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Koji Matsuo

Authors
  1. Ariane C. Youssefzadeh
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  2. Shinya Matsuzaki
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  3. Rachel S. Mandelbaum
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  4. Rauvynne N. Sangara
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  6. Kazuhide Matsushima
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  8. Koji Matsuo
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Contributions

Conceptualization: KoM, SM; data curation: RSM; formal analysis: KoM; funding acquisition: KoM; investigation: all authors; methodology: KoM; project administration: KoM; resources: all; software: RSM, KoM; supervision: KM, JGO; validation: KoM; visualization: KoM; writing—original draft: ACY, KoM; writing -review and editing: all authors.

Corresponding author

Correspondence to Koji Matsuo.

Ethics declarations

Conflict of interest

All were outside the work: honorarium, Chugai, textbook editorial expense, Springer, investigator meeting attendance expense, VBL Therapeutics (Ko.M.); research grant, Merck (S.M.); none for others.

Ethical approval

University of Southern California Institutional Review Board exemption (HS-16–00,481).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Transparency

The manuscript’s corresponding author (Ko.M.) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The National Inpatient Sample classified the race/ethnicity, and the current study used the default grou** for analysis.

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Youssefzadeh, A.C., Matsuzaki, S., Mandelbaum, R.S. et al. Trends, characteristics, and outcomes of conservative management for placenta percreta. Arch Gynecol Obstet 306, 913–920 (2022). https://doi.org/10.1007/s00404-021-06384-1

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  • DOI: https://doi.org/10.1007/s00404-021-06384-1

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