Maternal and Foetal Outcomes in Cesarean Hysterectomies Performed for Placenta Increta

Abstract

Background: Cesarean hysterectomy is a major surgical intervention, often performed as a last resort to manage life-threatening obstetric hemorrhage. Among its most severe indications is placenta increta, a form of abnormal placental adherence that invades the myometrium and can result in catastrophic blood loss, adjacent organ injury, and significant maternal morbidity. The rising incidence of cesarean deliveries has led to an increase in placenta accreta spectrum (PAS) disorders, particularly in resource-limited settings like Pakistan, where antenatal identification and conservative management options remain limited. Objective: This study aimed to evaluate the maternal and fetal outcomes associated with cesarean hysterectomies performed for placenta increta, and to identify clinical and surgical factors contributing to adverse outcomes in these cases. Methodology: A cross-sectional, descriptive study was conducted at a tertiary care hospital, PUMHS unit, and 2 wards, on 52 women who underwent cesarean hysterectomy over six months from December 06, 2023 to June 05, 2024. Among them, 23 cases were confirmed as placenta increta. Patients aged 20–45 years were included, with data collected on demographics, obstetric history, intraoperative findings, postoperative complications, and neonatal outcomes. Statistical analysis using SPSS version 25 included descriptive statistics and comparative tests to identify trends and significance. Results: The mean maternal age was 33.2 years, with a high prevalence of prior cesarean deliveries. In placenta increta cases, estimated blood loss averaged 3,386 mL, and 40.6% required ICU admission. Adjacent organ injury occurred in 13%, and postoperative complications such as fever (26.6%), UTIs (10.9%), and psychological distress (50%) were common. Despite increased maternal morbidity, neonatal outcomes were generally favorable, with a mean birth weight of 2.55 kg and no perinatal mortality observed in the increta group. Conclusion: Hysterectomies performed for placenta increta carry significantly higher risks of maternal complications, reflecting the aggressive nature of this condition and the need for multidisciplinary preparedness. These findings emphasize the importance of early antenatal detection, risk stratification, and institutional readiness to manage PAS disorders. Public health strategies must rationalize cesarean use, enhance diagnostic capacity, and develop national conservative and surgical management guidelines. Further research is essential to evaluate long-term maternal and psychological outcomes and to explore the feasibility of fertility-preserving options in selected cases.