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The following is a summary of “Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder,” published in the April 2025 issue of Obstetrics & Gynecology by Amro et al. 

Researchers conducted a retrospective study to assess maternal outcomes when leaving the placenta in situ for placenta accreta spectrum (PAS) based on planned surgical management.  

They assessed patients with PAS managed by leaving the placenta in situ from January 2015 to October 2024. At the center, patients were given alternatives to cesarean hysterectomy, including leaving the placenta in situ for planned uterine preservation or planned delayed hysterectomy. Maternal outcomes were analyzed, including infection risk, significant bleeding leading to hysterectomy, blood transfusion rates, and serious maternal morbidity. Outcomes were further analyzed based on the planned procedure (uterine preservation or delayed hysterectomy) and the final procedure executed (successful uterine preservation or interval hysterectomy).  

The results showed that of 180 patients with antenatal diagnosis of PAS, 50 were planned to leave the placenta in situ, 7 (14%) underwent cesarean hysterectomy due to antepartum or intraoperative hemorrhage, while 43 (86%) were managed by leaving the placenta in situ. Of the 43 managed with this approach, 5 (12%) required hysterectomy due to bleeding, and 4 (9%) developed endometritis and no cases of venous thromboembolism or maternal death. Among the 50 patients, 29 were planned for uterine preservation and 14 for delayed hysterectomy. Of the 29 planned for uterine preservation, 13 (45%) were successful, with a median time to expulsion or resorption of 17 weeks, 16 (55%) underwent interval hysterectomy, with 9 indicated and 7 due to patient request. Compared with 30 patients who underwent interval hysterectomy, those with successful uterine preservation (n = 13) had lesser median estimated total blood loss (700 mL vs 1,950 mL, P < .01), lower blood transfusion rates (31% vs 73%, P < .01), and fewer requiring >4 units of blood (8% vs 47%, P = .01) and 5 patients had subsequent pregnancies without placenta previa or PAS. No differences in median estimated total blood loss, blood transfusion rates, or transfusions exceeding 4 units were found when analyses were based on planned procedures (uterine preservation vs interval hysterectomy).  

Investigators concluded that leaving the placenta in situ was a viable alternative to cesarean hysterectomy for most patients with PAS, though the small sample size warranted caution in interpreting the results. 

Source: journals.lww.com/greenjournal/abstract/9900/leaving_placenta_in_situ_for_management_of.1253.aspx