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.
Surgery is the treatment of choice for early-stage cervical cancer, whereas radiation is conducted during all stages where the malignancy remains localized to the pelvis. Various surgical techniques, such as laterally extended parametrectomy, are alternative therapy options for patients with stage II-B and I-B cervical cancer and lymph node metastases. (Pálfalvi and Ungár, 2003) Previously, these patients were referred for radiation therapy or neoadjuvant chemotherapy.
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