92 Mode of cesarean hysterectomy for abnormally invasive placenta; comparing maternal and surgical complications

The goal of this review was to determine if patients undergoing total abdominal hysterectomy for abnormally invasive placenta (AIP) had any difference in timing of delivery, reason for delivery, and intra-operative complications compared to supracervical cesarean hysterectomy. We performed a retrospective cohort study of all patients that were suspected to have abnormally invasive placenta (placenta accreta, increta, or percreta) who had cesarean hysterectomy performed at a single institution between 2010 and 2020. Primary outcome was estimated blood loss. Secondary outcome was morbidity associated with cesarean hysterectomy including gestational age at delivery and intra-operative and postoperative complications. Maternal demographic data, pathology, and intra-operative outcomes were compared using unpaired t-test, Fisher’s exact test, and Pearson’s chi-squared test when appropriate. During this period, 43 women underwent cesarean hysterectomy for suspicion of abnormally invasive placenta. There were 25 women who underwent total abdominal cesarean hysterectomy (TACH) and 18 underwent supracervical cesarean hysterectomy (SCCH). Among the two groups, there was no difference in maternal age (33.6 vs 31.9 years old, P = 0.13), BMI (35.01 vs 33.15, P = 0.18), or prior number of cesarean sections (1.64 vs 1.72 prior sections, P = 0.38). Gestational age on admission was equal among cesarean hysterectomy type upon admission (33.05 WGA vs 32.46 WGA, P = 0.285) and upon delivery (34.08 WGA vs 33.54 WGA). Reason for delivery was significantly different among cesarean hysterectomy mode. 72.2 % of supracervical hysterectomies were unplanned and done emergently, whereas 36% of total hysterectomies for AIP were done emergently (P < 0.0001). For TACH, the total blood loss (2.8L vs 2.6L) was clinically higher although not statistically significant (P = 0.349). This was also true for the total number of products (red blood cells, FFP, platelets, or units of cell-saver) transfused intraoperatively, 8.4 products for TACH vs 6.3 products during SCCH (P = 0.307). The percentage of women needing transfusion intraoperatively was higher in SCCH although not statistically significant (77.8% vs 56.9%, P = 0.13). A higher number of bladder injuries occurred during TACH (40%) compared to SCCH (12.5%, P < 0.0001). There was no difference in bowel complications. Placenta accreta was the most common pathology; more patients underwent TACH for placenta accreta than SCCH (60.89% vs. 43.75%, P < 0.0001. There was no statistical difference in post-operative complications (urinary retention, bowel obstruction or ileus, percentage needing transfusion postoperatively, or need for re-operation). Our findings showed total abdominal cesarean hysterectomy for suspicion of placenta accreta, percreta, or increta has an increase in overall morbidity compared to supracervical cesarean hysterectomy, despite the fact that TACH was less likely to be performed in an unplanned, emergent fashion.