186: Factors influencing maternal outcome after cesarean hysterectomy for placenta accreta, increta and percreta

Abstract

To evaluate factors that influence maternal outcome in cesarean hysterectomy with invasive placenta We conducted a retrospective study of 121 women in a single institution requiring cesarean hysterectomy for invasive placenta between January 2005 and July 2017. Maternal age, BMI, number of prior cesareans, smoking, IVF, prior uterine surgery, maternal medical problems, obstetric complications, degree of invasion predicted by ultrasound and/or MRI, consultation with GYN Oncology, hypogastric artery ligation, uterine artery embolization, scheduled versus unscheduled hysterectomy were assessed for association with outcomes of blood loss, transfusion, ICU admission, prolonged hospital stay, surgery complications and operative time. Mean maternal age at delivery was 34, mean gravidity was 4, mean number of prior cesarean sections 1.94, mean gestational age at delivery 33.79 weeks, mean operating time was 140 minutes. 55.4% delivered at a scheduled time, the remainder delivered for an obstetric reason such as bleeding or labor. 67.7% required blood transfusion, 23% were admitted to ICU, and mean length of postpartum stay was 5.27 days. Preoperative GYN Onc consultation was associated with longer operating room times 121.27+/- 44.87 vs 149.23+/- 50.70 minutes (p < 0.01) but a lower likelihood of ICU admission, p<0.017. The EBL was lower in planned versus unplanned, 1827+/- 868 vs. 2647+/-1406 ml, p<0.001. Older gravidas were more likely to be admitted to ICU (p = 0.015) and need blood (p = 0.023). Ultrsasound was performed in all cases and was 81 % sensitive and 100 % specific for invasive placentation. MRI was performed in 71 was 82 % sensitive but not specific. In cases with ultrasound showing no invasion, 8 had MRI scans, with 2 true positives and 6 false positives for invasion. Ultrasound and MRI had similar sensitivity. In patients who already had an ultrasound diagnosis of invasive placenta, MRI did not add to the preoperative diagnosis. However, when ultrasound was read as normal, MRI was useful in predicting invasion. Older gravidas were more likely to get transfusion and need admission to ICU. GYN Oncology consultation was associated with longer operating time but less ICU admission. Blood loss was lower in patients with planned cesarean hysterectomy. Other prenatal factors did not significantly impact outcomes.