Prediction of success of uterus preserving management in women with placenta accreta spectrum (CON-PAS score): A multicenter international study.

Objective To create a model for prediction of success of uterine preserving procedures in women with placenta accreta spectrum (PAS) METHODS: PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1st, 2010 and December 31st, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. Results Out of 797 women with PAS, 587 were eligible. Uterus preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio "aOR" 0.02; 95% confidence interval "CI", 0.001-3.63 with 5 previous CSs). Other variables were complete placental invasion (aOR 0.14; 95%CI, 0.05-0.43), type of CS incision (aOR 0.04; 95%CI, 0.01-0.25 for classical incision), compression sutures (aOR 2.48; 95%CI, 1.00-6.16), accreta type (aOR 3.76; 95%CI, 1.13-12.53), incising away from placenta (aOR 5.09; 95%CI, 1.52-16.97), and uterine resection (aOR 102.57, 95%CI, 3.97-2652.74). Conclusion This current study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.