COMPARATIVE OUTCOMES OF TOTAL OBSTETRIC HYSTERECTOMY VS SUPRA-CERVICAL OBSTETRIC HYSTERECTOMY IN CASES OF PLACENTA PREVIA ALONG WITH PLACENTA ACCRETA SPECTRUM

Background: Placenta previa, particularly when associated with placenta accreta spectrum (PAS), poses significant challenges in obstetric care and increasing the risks of life-threatening maternal hemorrhage.

Aim- To compare outcomes of total obstetric hysterectomy (TOH) and supracervical obstetric hysterectomy (SCOH) in patients diagnosed with placenta previa and PAS.

Material & Methods: Observational study at Pt. JNM Medical College and Dr. BRAM Hospital, Raipur. Data taken of 136 cases of placenta previa, with 32 patients undergoing obstetric hysterectomy, of which 19 had PAS. Cases classified into two groups: TOH (n=7) and SCOH (n=12). Outcome variables were operative time, blood loss, maternal morbidity and mortality.

Results: 59% OH were done in cases of placenta previa associated with PAS. The incidence of Obstetric Hysterectomy due Placenta Previa with PAS was 0.13%. The mean blood loss was higher in the TOH group (1257 ± 408.6 mL) compared to the SCOH group (1100 ± 292.9 mL) (p=0.3). The operative duration was longer for TOH (157 minutes) than for SCOH (136 minutes, p=0.4). Postoperatively, complications such as severe anemia were comparable (85% in TOH vs. 90% in SCOH). Internal Iliac artery ligation prior to hysterectomy was associated with higher mean blood loss (p Value 0.01) and higher operative time (p Value 0.04). 2/19 cases lost their lives after hysterectomy. Mortality rate was 10.5% and was associated with severe PAS.

Conclusion: The study highlights the high incidence of PAS in obstetric hysterectomy. TOH and SCOH each have distinct advantages and risks that must be weighed against patient-specific factors. Direct proceeding to hysterectomy rather than after internal iliac artery ligation appear to be associated with better maternal outcome.