Abstract:Objective: To investigate the factors influencing hysterectomy on patients with placenta accreta spectrum disorders (PAS), explore the best treatment of PAS, and reduce the proportion of hysterectomy. Methods: A retrospective study was conducted among 269 pregnant women who diagnosed with PAS and underwent cesarean section (CS) between January 1, 2015 and December 31, 2021 in Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, and they were divided into hysterectomy group (study group) and non-hysterectomy group (control group). The related factors of hysterectomy were compared between the two groups, including basic characteristics, antepartum hemorrhage (early pregnancy bleeding, bleeding in the second and third trimester of pregnancy), type of placenta accreta, pernicious placenta previa (PPP), pregnancy complications (gestational hypertension, gestational diabetes, intrahepatic cholestasis of pregnancy), image diagnosis of PAS before the operation (ultrasound or nuclear magnetic reso-nance), abdominal aorta balloon occlusion, emergency CS, infant birth weight, position of fetus, and so on. Univariate and multivariate logistic analyses were used for statistical analysis. Results: There were significant differences between the two groups in pregnancy times, parity, previous CS times, intrauterine adhesion history, second and third trimester bleeding, PPP, preoperative imaging diagnosis of placenta accreta, abdominal aortic balloon occlusion, gestational age and newborn weight (P<0.05). In multivariate logistic analysis, history of interuterine adhesions, type of placenta accreta and PPP were independent risk factors affecting hysterectomy (OR>1, P<0.05), and middle and late antepartum hemorrhage and CS were independent protective variables affecting hysterectomy (OR<1, P<0.05). Conclusion: Women with PAS complicated with history of interuterine adhesions, PPP and more extent of placenta accreta have significantly higher risks of hysterectomy than women without hysterectomy, and middle and late antepartum hemorrhage and longer gestational age can reduce the risk of hysterectomy.
