A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach

Abstract Background Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimize blood loss. Methods We conducted a monocentric retrospective cohort study including all patients operated for PAS between 2006 and 2023. During this period, one-step surgery was abandoned and a two-step surgical approach was adopted. The number of units of red blood cells (RBC) needed during surgery were the primary outcomes used to compare these two approaches. Results A total of 43 cases were included in this analysis. Median blood loss during surgery was 2000 ml and 2800 ml for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBC was 0.28 (95%-CI: 0.063 ‒ 1.15, p = 0.067). Longer interval between the caesarean section and the second operation showed a trend to lower blood loss (p = 0.065) and were associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusion Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction of blood transfusion. Leaving the placenta in situ and delay final operation represents a possible alternative to traditional cesarean hysterectomy (one-step surgery).