To investigate the related factors of hysterectomy in patients with placenta previa combined with placenta accrete.

From January 2017 to October 2021, the clinical data of 444 patients with placenta previa combined with placenta accrete who delivered after the 28th week of pregnancy in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Among them, 152 patients (34.2%) had a hysterectomy as the research group, and 292 patients (65.8%) had no hysterectomy as the control group. Univariate analysis was performed on the general situation, factors related to the previous cesarean section, and factors related to operation in the two groups, and multivariate analysis was performed by Logistic regression.

There were statistically significant differences between the two groups in pregnancy times (≤1次: 69.18% vs 43.42%; 2次: 27.40% vs 46.71%; ≥3次: 3.42% vs 9.87%; χ²=29.323), history of placenta previa (3.42% vs 9.87%, χ²=7.757), previous cesarean section times (0次: 23.63% vs 7.24%; 1次: 56.85% vs 47.37%; ≥2次: 19.52% vs 45.39%; χ²=40.168), gestational age of first diagnosis of placenta previa (<12 weeks: 0.34% vs 5.26%; 12~27^{+ 6} weeks: 29.11% vs 55.92%; ≥26 weeks: 70.55% vs 38.82%; χ²=47.637), intraoperative blood loss (900 ml vs 1500 ml; Z=-8.164), placenta implantation degree (adhesions: 82.19% vs 34.87%; implantation: 13.36% vs 23.03%; penetration: 4.45% vs 42.11%; χ²=121.255)(P<0.05). Logistic regression analysis showed that parity, degree of placenta accreta, intraoperative blood loss and gestational age of first diagnosis of placenta accreta were independent risk factors for placenta previa combined with placenta accrete hysterectomy.

The parity, the degree of placenta accreta, the amount of intraoperative blood loss and the gestational age of the first diagnosis of placenta accreta are independent risk factors for placenta previa combined with placenta accrete hysterectomy. The earlier the diagnosis of placenta accreta, the higher the parity and the degree of placenta accreta, and the greater the risk of hysterectomy. Paying attention to prenatal care and preoperative risk assessment of such patients are essential to reduce hysterectomy.