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Uterus Preservation Versus Caesarean Hysterectomy in Management of Placenta Accreta Spectrum: A Multicentre International Study
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  • Sherif Shazly,
  • Ismet Hortu,
  • Jin-chung Shih,
  • Rauf Melekoglu,
  • Shangrong Fan,
  • Farhatulain ahmed,
  • Erbil Karaman,
  • Ildar Fatkullin,
  • Pedro Pinto,
  • Setyorini Irianti,
  • Joel Tochie,
  • Amr Abdelbadie,
  • Mohamed Ashraf,
  • Ahmad Radwan,
  • Esraa Sayed,
  • Gena Elassall,
  • Esraa Hosny,
  • Shimaa Ali,
  • Ayman Dawood,
  • A. Mete Ergenoglu,
  • Ahmet Yeniel,
  • Sermet Sagol,
  • Ismail Itil,
  • Jessica Kang,
  • KUAN-YING HUANG,
  • Ercan Yilmaz,
  • Yiheng Liang,
  • Hijab Aziz,
  • Tayyiba Akhter,
  • Afshan Ambreen,
  • Çağrı Ateş,
  • Yasemin Karaman,
  • Albir Khasanov ,
  • Larisa Fatkullina ,
  • Nariman Akhmadeev,
  • Adelina Vatanina ,
  • Ana Machado,
  • Nuno Montenegro,
  • Jusuf Effendi,
  • Dodi Suardi,
  • Ahmad Pramatirta,
  • Muhamad Aziz,
  • Amilia Siddiq,
  • Ingrid Ofakem,
  • Julius Dohbit,
  • Mohamed Fahmy,
  • Mohamed Anan
Sherif Shazly

Corresponding Author:sherify2k2@gmail.com

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Ismet Hortu
Ege University
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Jin-chung Shih
National Taiwan University Hospital, National Taiwan University College of Medicine
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Rauf Melekoglu
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Shangrong Fan
Peking University Shenzhen Hospital
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Farhatulain ahmed
Department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Punjab, Pakistan
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Erbil Karaman
Yuzuncu Yil University Faculty of Medicine
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Ildar Fatkullin
Kazan State Medical University
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Pedro Pinto
Centro Hospitalar de São João EPE
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Setyorini Irianti
Universitas Padjadjaran
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Joel Tochie
Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Amr Abdelbadie
Department of Obstetrics and Gynaecology, Aswan University Hospital, Aswan, Egypt
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Mohamed Ashraf
Assiut University Faculty of Medicine
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Ahmad Radwan
Assiut University
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Esraa Sayed
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Gena Elassall
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Esraa Hosny
Assiut University
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Shimaa Ali
Assiut University
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Ayman Dawood
Assiut University
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A. Mete Ergenoglu
Ege University
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Ahmet Yeniel
Ege Universitesi
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Sermet Sagol
Ege Universitesi
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Ismail Itil
Ege Universitesi
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Jessica Kang
National Taiwan University Hospital, National Taiwan University College of Medicine
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KUAN-YING HUANG
National Taiwan University Hospital
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Ercan Yilmaz
Inonu University School of Medicine
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Yiheng Liang
Peking University
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Hijab Aziz
Fatima Memorial Hospital
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Tayyiba Akhter
Fatima Memorial Hospital
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Afshan Ambreen
Fatima Memorial Hospital
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Çağrı Ateş
Yuzuncu Yil University Faculty of Medicine
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Yasemin Karaman
Van Lokman Hekim Hayat Hospital
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Albir Khasanov
Kazan State Medical University
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Larisa Fatkullina
Kazan State Medical University
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Nariman Akhmadeev
Kazan State Medical University
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Adelina Vatanina
Kazan State Medical University
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Ana Machado
Centro Hospitalar de São João EPE
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Nuno Montenegro
Centro Hospitalar de São João EPE
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Jusuf Effendi
Universitas Padjadjaran
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Dodi Suardi
Universitas Padjadjaran
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Ahmad Pramatirta
Universitas Padjadjaran
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Muhamad Aziz
Universitas Padjadjaran
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Amilia Siddiq
Universitas Padjadjaran
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Ingrid Ofakem
University of Yaounde I
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Julius Dohbit
University of Yaounde I
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Mohamed Fahmy
Aswan University
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Mohamed Anan
Aswan University
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Abstract

Objective: To compare peripartum outcomes of uterus preserving procedures to caesarean hysterectomy in women with placenta accreta spectrum (PAS), and to identify risk factors associated with adverse maternal outcomes. Design: Retrospective study (ClinicalTrials.gov identifier: NCT04384510) Setting:11 tertiary centres from 9 countries Population or Sample: women with of PAS who were managed in participating centres between January 1st, 2010 and December 31st, 2019. Women who had confirmed diagnosis with PAS with adequate documentation and follow-up, were considered eligible. Main Outcome Measures: Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Results: Out of 797 women, 727 were eligible for the study. Five hundred ninety-two (81.43%) women were managed by uterus preserving procedures versus 135 (18.56%) who underwent caesarean hysterectomy. After adjustment for significant or close-to-significance variables, type of management was not associated with higher risk of massive blood loss (aOR 1.71, 95% CI 0.78 - 3.81). Other factors that were significantly associated with higher risk of massive PAS-associated blood loss included body mass index, preoperative haemoglobin, centrally located placenta, diffuse placental invasion, parametrial invasion, and intrauterine foetal death. Conclusions: In the presence of sufficient experience, uterus preserving procedures may not be associated with higher risk of massive blood loss compared to caesarean hysterectomy. Funding: none