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Outcomes Following a Clinical Algorithm Allowing for Delayed Hysterectomy in the Management of Severe Placenta Accreta Spectrum

group underwent induction and augmentation of labor, delivered in the operating room, experienced a longer duration of labor, and endured a greater volume of blood loss. As predicted, the spontaneous vaginal delivery group reported significantly better recovery scores. Additional subgroup analysis reported higher ObsQor-10 scores for women undergoing spontaneous vaginal delivery without epidural analgesia, when compared with their epidural analgesia counterparts, but this group also experienced significantly worse nausea and pain. They also reported significantly better feelings of control, ability to feed and hold their babies, and comfort in the recovery state. The study confirmed the hypothesis that on postpartum day 1, spontaneous vaginal delivery was associated with better recovery quality than operative vaginal delivery. Women with spontaneous vaginal delivery also reported improved abilities to hold and feed the baby 1 day postpartum, which is possibly a contributing factor to the higher successful breastfeeding rate at 1 month. However, while the study demonstrated the difference in quality of recovery between modes of delivery, there remains no clear diagnosis for the cause of disparity. Likely the cause is a result of multiple factors in the obstetric, anesthetic, medical, and psychosocial categories. Also, the operative vaginal delivery group may have manifested worse recovery outcomes in this particular study because of a variety of confounding variables, including oxytocin infusion, estimated blood loss, primiparous patient proportion, duration of labor, preexisting diagnosis of cardiac disease, and the requirement for anesthetic and surgical interventions in the operating room to facilitate delivery. Potential limitations of the study include a lack of 1:1 ratio in the groups, but this limitation was anticipated, allowing for a sample size adequate to overcome it. In addition, the convenience sample of patients does render the study’s data vulnerable to selection bias, indicating that additional studies in various facilities are necessary to determine the generalizability of the study results. The data from the forceps and vacuum-assisted operative vaginal deliveries were combined despite the individual recovery profiles that these procedures may entail. Recovery on day 1 of the postpartum period is conclusively better in women undergoing spontaneous vaginal delivery (in comparison to those undergoing operative vaginal delivery). These data are valuable for the development of future therapeutic interventions, as well as educational materials for women. This study successfully identified a group of women likely to benefit from addressing poorly scored recovery domains (using ObsQor-10) through enhanced recovery strategic approaches.