Uterine Preservation and Maternal Outcomes Across FIGO Severity in Placenta Accreta Spectrum: A Six-Year Retrospective Cohort in Vietnam

Background/Objectives: Uterus-preserving management of placenta accreta spectrum (PAS) is increasingly reported, but preservation rates are difficult to interpret without considering disease severity and maternal morbidity. We aimed to estimate short-term uterine preservation through hospital discharge and describe maternal outcomes by FIGO clinical severity. Methods: We conducted a retrospective single-center cohort study of 291 women with clinically diagnosed PAS and intraoperative FIGO grading who underwent cesarean delivery at Hung Vuong Hospital, a tertiary maternity referral hospital in Vietnam, from 2019 to 2024. The primary outcome was short-term uterine preservation through hospital discharge, defined as no hysterectomy during the index operation or before discharge. Secondary and exploratory analyses described hemorrhage and maternal morbidity across FIGO severity. Results: Short-term uterine preservation through hospital discharge was achieved in 282/291 women (96.9%; 95% CI 94.2–98.4), including 72/79 with FIGO grade 3 (91.1%; 95% CI 82.8–95.6). Major hemorrhage occurred in 81/291 (27.8%) and severe maternal morbidity in 25/291 (8.6%); no maternal deaths occurred. In FIGO grade 3, major hemorrhage occurred in 51/79 (64.6%), high-volume red-cell transfusion in 37/79 (46.8%), and severe maternal morbidity in 21/79 (26.6%). Conclusions: Most women retained the uterus through hospital discharge in this cohort, but women with FIGO grade 3 had high rates of hemorrhage, transfusion, and maternal morbidity. Without a concurrent planned-hysterectomy comparator, this study cannot compare the effectiveness of uterine preservation with hysterectomy.