Timing of cesarean section in women with risk factors for placenta accreta spectrum disorder and maternal outcomes: A descriptive study

OBJECTIVE: This study reports maternal outcomes in women with risk factors for placenta accreta spectrum disorder (PAS) with cesarean section on the scheduled date and before in a setting where the intention was to wait at least until 36 weeks of gestation. METHODS: We performed a descriptive analysis using data from a retrospective nationwide cohort study, including 513 women with risk factors for PAS (placenta previa + history of one or more cesarean section) with or without abnormal ultrasonography, conducted across 69 Dutch hospitals. The main outcome measure was the total volume of perioperative blood loss (mL). RESULTS: Of all 513 women, 237 women (46%) underwent cesarean section on the scheduled date, while 276 women (54%) had a cesarean section before the scheduled date. Among these 276, 88 (32%) occurred in a controlled, semi-urgent setting and 188 (68%) in an emergency setting; blood loss was the most common indication. Median blood loss was 900 mL (interquartile range [IQR] 500-2000) in women with a cesarean section on the scheduled date, compared to 1000 mL (IQR 600-2500) in those who underwent cesarean section before the scheduled date. Of 353 women with a cesarean section scheduled at 37 weeks or later, 101 (29%) underwent the procedure in an emergency setting. CONCLUSION: In women with risk factors for PAS, the timing of scheduled cesarean section later than 36 weeks did not show an evident increase in adverse maternal outcomes (perioperative blood loss, red blood cell transfusion and intensive care unit admission). Given the heterogeneity of PAS and the descriptive nature of this study, these findings should be interpreted with caution. Individualized timing of cesarean section remains essential, taking into account PAS severity and available resources.