Comparative Analysis of Myometrial Resection (Myomectomy) Versus Cesarean Hysterectomy

Objectives: 

This study aims to evaluate the outcomes of pregnant women with a prior PAS-related pregnancy who underwent resective-conservative surgery (myectomy) during cesarean section. It focuses on the incidence of spontaneous preterm birth, uterine rupture, hysterectomy due to severe hemorrhage, and myometrial thinning in subsequent pregnancies. The study also analyzes neonatal health indicators like Apgar scores, birth weight centiles, and small-for-gestational-age rates, ultimately assessing the impact of conservative surgery on maternal and neonatal health in future pregnancies.

Design:

The study utilizes a retrospective cohort design to evaluate outcomes in pregnant women with a history of Placenta Accreta Spectrum (PAS) disorders who underwent conservative resective surgery (myectomy) during a previous cesarean section. It focuses on assessing maternal and neonatal health in subsequent pregnancies, with a sample size of 50 women over one year. The study aims to identify complications and health outcomes in women who had conservative surgery for PAS.

Methodology: 

This retrospective study, conducted at the Maternal and Child Health Department, PIMS, Islamabad, analyzed the medical records of 50 pregnant women who underwent conservative resective surgery (myectomy) for Placenta Accreta Spectrum (PAS) disorders during cesarean section. It examines maternal and neonatal outcomes in subsequent pregnancies, focusing on preterm birth, uterine rupture, hysterectomy, myometrial thinning, and neonatal health. Data collected from January to December 2023 will help assess the impact of conservative surgery on future maternal and neonatal health.

Results:

Out of 26 patients who underwent conservative surgery (myectomy) for Placenta Accreta Spectrum (PAS), 10 had uneventful pregnancies with repeat cesareans at 37+ weeks. Complications included preterm rupture of membranes, premature labor, hypertension, uterine atony, overweight, and gestational diabetes. The average patient age increased from 30 to 36 years. Uterine segments were generally thicker, with one case of partial uterine dehiscence. No placenta previa or PAS was observed, and one hysterectomy was performed at the patient's request.

Conclusion: 

The study concluded that while the incidence of Placenta Accreta Spectrum (PAS) has increased, conservative resective surgery (myectomy) for PAS shows favorable maternal and neonatal outcomes in subsequent pregnancies. The outcomes were similar to those of typical pregnancies and cesarean deliveries. Despite some complications like preterm labor and uterine atony, the study suggests that conservative surgery can be a viable option for managing PAS without significantly compromising maternal and fetal health in future pregnancies.