Termination of a second-trimester pregnancy with placenta accreta spectrum disorder

ABSTRACT

Background: The termination of pregnancy in patients with placenta accreta spectrum disorder (PASD) during the second trimester remains uncertain. In addition, interventional radiology techniques, such as arterial embolization and balloon placement, are potential options. We evaluated the outcomes of pregnancy termination in patients with PASD during the second trimester and the effectiveness of preoperative interventional radiology techniques.

Methods: This retrospective study analyzed 48 PASD patients who underwent pregnancy termination during the second trimester between January 2016 and May 2021.

Results: Of the 48 patients, 20 (41.67%) underwent transvaginal termination, whereas 28 (58.33%) underwent cesarean section. Notably, no significant differences were observed in success rates between the transvaginal termination and cesarean section groups (80.00% vs. 92.86%, P = 0.38). Furthermore, no statistically significant differences were observed in the success rates (94.12% vs 90.32%, P = 1.00) and blood loss (512.35 ± 727.00 ml vs 804.00 ± 838.98 ml, P = 0.23) between the artery embolization and non-embolization groups. In the vaginal termination group, statistically significant differences were observed in gestational weeks (16.70 ± 3.12 vs 22.67 ± 3.63, P < 0.01) and blood loss (165.00 ± 274.43 ml vs 483.64 ± 333.53 ml, P = 0.04) between the (artery embolization and non-embolization) subgroups. Conversely, in the cesarean section group, no significant differences were observed in gestational weeks (23.59 ± 3.14 vs 23.20 ± 4.37, P = 0.79) and blood loss (811.11 ± 879.55 ml vs 989.47 ± 986.52 ml, P = 0.76) between the subgroups.

Conclusions: Further studies are needed to evaluate the efficacy of vaginal termination in PASD patients during the second trimester. Regarding cesarean termination, arterial embolization did not demonstrate increased effectiveness.

KEYWORDS:

• Placenta accreta spectrum
• second trimester
• surgery
• vaginal delivery
• artery embolization

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Conceptualization, JH; Data curation, CH and JH; Formal analysis, QL and JH; Funding acquisition, WZ, CP, KF, QL and JH; Investigation, CH and JH; Methodology, WZ, JH and QL; Resources, YZ, CP, XW, KF, QP, JZ; Writing – original draft, JH; Writing – review & editing, JH and QL.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research was funded by the Natural Science Foundation of Hunan Province (2022JJ40789, 2023JJ40980, 2023JJ40958, 2020JJ5890), China Postdoctoral Science Foundation (2022M723555), the National Natural Science Foundation of China (82301927, 82371700, 81974236, 81571516, 81903696), the Major Scientific and Technological Projects for Collaborative Prevention and Control of Birth Defects in Hunan Province (2019SK1010, 2019SK1015), the Key Research and Development Program of Hunan Province (2020SK2072), the Scientific Research Project of Hunan Provincial Development and Reform Commission (2021212), the Scientific Research Project of Hunan Provincial Health Commission (202105022347).