Placenta Accreta Spectrum: Maternal Outcomes Following Conservative Management and Obstetric Hysterectomy at a Tertiary Care Hospital

Abstract

Objective: To compare maternal outcomes in patients with PAS disorders managed conservatively versus those undergoing obstetric hysterectomy.

Methodology: A quasi-experimental study was conducted at Pak Emirates Military Hospital, Rawalpindi. Fifty-seven patients diagnosed with PAS were included; 25 underwent obstetric hysterectomy, and 32 received conservative management. Data was analyzed for estimated blood loss, operative time, hospital stay, and need for ventilatory support. Statistical significance was set at p < 0.05.

Results: The mean patient age was 32.37 ± 3.23 years, and the mean number of previous cesarean sections was 1.97 ± 0.84. The hysterectomy group demonstrated significantly higher estimated blood loss (2.76 L vs. 1.45 L), longer operating times (3.28 hrs vs. 2.59 hrs), and longer hospital stays (5.96 days vs. 3.94 days) compared with the conservative group (p < 0.001 for all). Ventilatory support was required more frequently in the hysterectomy group (p = 0.016).

Conclusion: Conservative management of PAS, when applied to carefully selected patients, is associated with reduced intraoperative blood loss, shorter operative times, and faster recovery compared to hysterectomy. These findings emphasize the importance of individualized, multidisciplinary decision-making to optimize maternal outcomes while preserving fertility potential.

Keywords: Placenta accreta spectrum, conservative management, cesarean hysterectomy, maternal morbidity, fertility preservation.