Prediction of success of uterus‐preserving management in women with placenta accreta spectrum (CON‐PAS score): A multicenter international study
Sherif A. Shazly, İsmet Hortu, Jin‐Chung Shih, Rauf Melekoğlu, Shangrong Fan, Farhat ul Ain Ahmed, Erbil Karaman, И. Ф. Фаткуллин, Pedro Viana Pinto, Setyorini Irianti, Joël Noutakdie Tochie, Amr S. Abdelbadie, Mohamed Salah, Hossam Aldein S Abd Elazeem, Mahmoud Saad, Ahmet Mete Ergenoğlu, Ahmet Özgür Yeniel, Sermet Sağol, Ismail M. Itil, Jessica Kang, Kuan‐Ying Huang, Ercan Yılmaz, Yiheng Liang, Hijab Aziz, Tayyiba Akhter, Afshan Ambreen, Çağrı Ateş, Yasemin Karaman, А. А. Хасанов, L. S. Fatkullina, Nariman R Akhmadeev, Adelina Vatanina, Ana Paula Machado, Nuno Montenegro, Jusuf Sulaeman Effendi, Dodi Suardi, Ahmad Y. Pramatirta, Muhamad A. Aziz, Amilia Siddiq, Ingrid Ofakem, Julius Sama Dohbit, Mohamed S. Fahmy, Mohamed A. Anan
Abstract
OBJECTIVE: To create a model for prediction of success of uterine-preserving procedures in women with placenta accreta spectrum (PAS). METHODS: PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. RESULTS: Out of 797 women with PAS, 587 were eligible. Uterus-preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001-3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05-0.43), type of CS incision (aOR 0.04, 95% CI 0.01-0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00-6.16), accreta type (aOR 3.76, 95% CI 1.13-12.53), incising away from placenta (aOR 5.09, 95% CI 1.52-16.97), and uterine resection (aOR 102.57, 95% CI 3.97-2652.74). CONCLUSION: The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.