Akademik Veri Yönetim Sistemi
Clinical and Experimental Obstetrics and Gynecology, cilt.52, sa.7, 2025 (SCI-Expanded)
Background: Placenta accreta spectrum (PAS) is a condition associated with high maternal mortality and morbidity rates due to intraoperative massive bleeding. There is currently no consensus regarding the optimal gestational age at which elective surgery should be performed to reduce the potential complications of PAS. In PAS disorders, the optimal gestational week for intervention is carefully determined to improve neonatal survival and health outcomes while minimizing maternal mortality and the risk of complications associated with surgical treatment. The aim of this study was to evaluate the surgical outcomes of patients who underwent caesarean hysterectomy for PAS in our clinic, according to the timing of the procedure, to be able to predict potential complications and plan delivery time. Methods: Following a retrospective review of patients who underwent caesarean hysterectomy for PAS in our clinic, a total of 117 cases were included in the study. The patients included in the study were divided into five groups based on gestational age at the time of surgery: Group 1 (<34 weeks), Group 2 (≥34 weeks–35 weeks<), Group 3 (≥35 weeks–36 weeks<), Group 4 (≥36 weeks–37 weeks<), Group 5 (≥37 weeks). The groups were compared in terms of demographic data, hematological parameters, histopathological classification, surgical approach, early and late maternal complications, and neonatal outcomes. Results: No significant differences were observed among groups regarding demographics, intraoperative and postoperative blood transfusions, or maternal complication rates. Neonatal outcomes, excluding asphyxia, significantly improved with advancing gestational age, with the best results after 37 gestational weeks. However, maternal clinical complications increased beyond 37 gestational weeks. No significant association was found between histopathological classifications and transfusion requirements. Emergency surgeries were associated with longer intensive care unit (ICU) stays and higher transfusion needs. No significant differences in complication rates were found between the groups including between patients who underwent planned (elective) and unplanned (emergency) surgeries. Conclusions: This study demonstrated that PAS surgeries performed up to the 37th gestational week significantly improved neonatal outcomes without increasing maternal complication rates. Although neonatal outcomes were optimal after 37 weeks, a clinically significant rise in maternal complications was observed. Moreover, emergency surgeries were associated with longer ICU stays and higher blood transfusion requirements compared to elective procedures. These findings suggest that, in appropriately selected patients, postponing PAS surgery until 37 weeks of gestation, under close surveillance and multidisciplinary management, can enhance neonatal outcomes without increasing maternal morbidity.