Hysterectomy in Pregnant Women with a Diagnosis of Placenta Previa

Low-lying placenta and placenta previa are important obstetric conditions with high morbidity among the mother and fetus. These conditions are risk factors for postpartum hemorrhage (PPH), placenta accreta spectrum (PAS), and peripartum hysterectomy. Aim to find the incidence of hysterectomy in pregnant women with diagnosis of Low-Lying Placenta or Placenta Previa and to find maternal, obstetric, intraoperative risk factors, outcome of mother and influence of placental type and placental adherence on surgical and maternal outcome. This study was a prospective observational study carried out in Al-Basra Maternity and Children Hospital between April 2024 and April 2025. All women with ultrasonic placental measurements of low-lying placenta and placenta previa between 24–40 weeks' gestation were included. A pre-designed questionnaire was used for data collection and operative and medical records were checked. Maternal characteristics, ultrasound findings, intraoperative events, were assessed. The main outcome was hysterectomy and secondary outcomes were identification of associated risk factors. Results of the 115 cases analyzed, 22 women (19-1%) underwent hysterectomy and 93 (80-9%) did not. The mean maternal age was 30.16 ± 5.7 years and mean BMI was 25.69 ± 5.11. Most frequent indications for hysterectomy were placental bed postpartum hemorrhage (PPH) (11 cases, 50%), placenta accreta spectrum PPH (6 cases, 27.3%) and uterine atony PPH (5 cases, 22.7%). Hysterectomy was significantly more frequent among women aged ≥35 years (54.5% vs. 22.6%, p = 0.03) and those with placenta previa stage ≥3 (100% vs. 43%, p < 0.001). One case of maternal mortality (4.55%) was seen in the hysterectomy group and none (0%) in the non-hysterectomy group (p = 0.007). Hysterectomy is an important life-saving procedure in low-lying placenta and placenta previa and is significantly dependent on the PAS, obstetric history, and operative factors. Careful imaging and prenatal assessment are important to identify high-risk patients early in order to reduce morbidity and improve outcome. The purpose of this study is to determine the necessity of early diagnosis, special care and timing of surgical intervention for optimal results in this high-risk patient group.