The role of supracervical hysterectomy in reducing blood products requirement in the management of placenta accreta: a case-control study

Objective:While surgical management is the treatment of choice for abnormally invasive placenta, the role of supracervical hysterectomy in this setting is not well established. We aimed to compare supracervical versus total cesarean hysterectomy as a surgical option for abnormally invasive placenta. Methods:We carried out an 8-year retrospective case-control study. Six cases of a patient treated by total hysterectomy were matched and compared to 30 controls treated by supracervical hysterectomy. Matching of cases with controls was based on coexisting placenta previa, a number of previous cesarean sections, and age, with five controls per case. Cases and controls were comparable in placental invasion topography. We compared the operative approach in all histologically identified cases of abnormally invasive placenta. Results:Overall, 36 women with histologically proven abnormally invasive placenta were identified. Composite blood products morbidity was higher among total hysterectomy patients (p= .02). Freshly frozen plasma utilization was greater among total hysterectomy patients (p= .01). Median operative time (142 +/- 48 versus 136 +/- 58 minutes) and hospitalization time (8.9 +/- 3.1 versus 7.3 +/- 1.5 days) were comparable between those who underwent supracervical versus total hysterectomy (p> .05). No case of maternal or neonatal death was encountered. Conclusion:The favorable maternal and perinatal outcomes observed in our study, suggest that supracervical hysterectomy should be considered as the first-line approach in cases of abnormally invasive placenta managed operatively.