{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:46:41Z","timestamp":1785887201201,"version":"3.56.0"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"Ensign Endowment for Gynecologic Cancer Research","award":["1R01HD104943"],"award-info":[{"award-number":["1R01HD104943"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cesarean hysterectomy for placenta accreta spectrum (PAS) is associated with significant morbidity. The role of adjunctive procedures, including tranexamic acid administration, ureteral stent placement, and endoarterial embolization or balloon placement, in mitigating surgical morbidity during cesarean hysterectomy for PAS is currently under active investigation. This study aimed to assess temporal trends, characteristics, and outcomes associated with adjunctive procedures during cesarean hysterectomy for PAS.<\/jats:p>\n                  <jats:p>This retrospective study used the Premier Perspective database in the United States. The study population included pregnant patients who underwent cesarean hysterectomies for PAS between 2016 and 2023. Targeted adjunctive procedures included tranexamic acid administration, ureteral stent placement, and endoarterial embolization or balloon placement. A multivariate model was created to assess the association between adjunctive procedures and surgical morbidity.<\/jats:p>\n                  <jats:p>Among 4,337 cesarean hysterectomies for PAS, 39.3%, 24.6%, and 16.1% received tranexamic acid, ureteral stent placement, and endoarterial embolization or balloon placement, respectively. During the 8-year study period, tranexamic acid administration increased 5.7-fold from 11.7% to 66.4%, and ureteral stent placement increased 1.6-fold from 19.2% to 30.3% (both p-trend &lt;0.001). Nearly two-thirds of patients had postpartum hemorrhage (62.6%), and nearly one in five had urinary tract injury (18.7%). These three adjunctive procedures were not associated with decreased postpartum hemorrhage or urinary tract injury.<\/jats:p>\n                  <jats:p>These data suggest that the utilization of tranexamic acid and ureteral stent placement is increasing during cesarean hysterectomy for PAS in the United States. Reflecting the increases in real-world practice, whether these adjunctive procedures improve surgical morbidity of cesarean hysterectomy for PAS warrants further investigation with prospective studies.<\/jats:p>","DOI":"10.1055\/a-2914-4167","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:21:00Z","timestamp":1784589660000},"source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Adjunctive Procedures during Cesarean Hysterectomy for Placenta Accreta Spectrum"],"prefix":"10.1055","author":[{"given":"Naoko","family":"Komura","sequence":"first","affiliation":[{"name":"Graduate School of Medicine, The University of Osaka, Osaka Prefecture, Japan","place":["Suita"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Huang","sequence":"first","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York, United States","place":["New York"],"department":["Department of Obstetrics and Gynecology, Division of Gynecologic Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5725-9994","authenticated-orcid":false,"given":"Shinya","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Graduate School of Medicine, The University of Osaka, Osaka Prefecture, Japan","place":["Suita"],"department":["Department of Obstetrics and Gynecology"]},{"name":"Osaka International Cancer Institute, Osaka, Japan","place":["3-1-69 Otemae, Chuo-ku"],"department":["Department of Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaira N.","family":"Chavez Jimenez","sequence":"additional","affiliation":[{"name":"Los Angeles General Medical Center, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay F.","family":"Pon","sequence":"additional","affiliation":[{"name":"Los Angeles General Medical Center, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadira L.","family":"Bribiesca Leon","sequence":"additional","affiliation":[{"name":"Los Angeles General Medical Center, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Yao","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, California, United States","place":["Los Angeles"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-8701","authenticated-orcid":false,"given":"Koji","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Los Angeles General Medical Center, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology"]},{"name":"University of Southern California, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology, Division of Gynecologic Oncology"]},{"name":"Norris Comprehensive Cancer Center, University of Southern California, California, United States","place":["Los Angeles"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph G.","family":"Ouzounian","sequence":"additional","affiliation":[{"name":"University of Southern California, California, United States","place":["Los Angeles"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Buckley de Meritens","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York, United States","place":["New York"],"department":["Department of Obstetrics and Gynecology, Division of Gynecologic Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York, United States","place":["New York"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York, United States","place":["New York"],"department":["Department of Obstetrics and Gynecology, Division of Gynecologic Oncology"]},{"name":"Tufts Medical Center, Massachusetts, United States","place":["Boston"],"department":["Department of Obstetrics and Gynecology, Division of Gynecologic 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Matsuzaki","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/AOG.0000000000005929","article-title":"Placenta accreta spectrum, present and future: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop Summary","volume":"145","author":"C M Duzyj","year":"2025","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"e2521909","DOI":"10.1001\/jamanetworkopen.2025.21909","article-title":"Guidelines on placenta accreta spectrum disorders: a systematic review","volume":"8","author":"G Bonanni","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/AOG.0000000000004957","article-title":"Prophylactic ureteral stent placement and urinary injury during hysterectomy for placenta accreta spectrum","volume":"140","author":"M A 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