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

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.