Outcome of Stepwise Uterine Sparing Approach as a Conservative Surgical Management of Placenta Accreta
Journal Title: Gynecology and Obstetrics Research – Open Journal - Year 2017, Vol 4, Issue 2
Abstract
Introduction: The incidence of placenta accreta is rising as a consequence of increased rate of cesarean sections and placenta previa which is the strongest risk factor. Intractable postpartum hemorrhage associated with placenta accrete is a leading direct cause of maternal morbidity and mortality. Major surgical modalities were described for management of placenta accreta like hysterectomy, systemic pelvic devascularization, stepwise surgical measures, intervention radiology methods and massive blood transfusions, all were recommended to be used for successful management and saving the maternal life. Patients and Methods: Fifty cases of placenta accrete were included in our study. They were selected from Obstetrics and Gynecology Department at Tanta University Hospital diagnosed by ultrasound (US) and magnetic resonance imaging (MRI). Pre-operative evaluation, laboratory investigations, and cross matched blood were done. Stepwise uterine sparing technique included simply: double ligation of uterine artery at two different levels on both sides before and after placental removal, lower at level of uterine isthmus and higher for utero-ovarian vessels ligation. Hemostatic quadruple sutures with sewing the placental bed were applied for control bleeding at the placental site attachment. Finally insertion of triple way Foley’s catheter through the cervix and inflation to 50 cc saline to compress lower uterine segment and drain bleeding. Results: The stepwise uterine sparing procedure achieved a high success rate 96%. From a total 50 cases with placenta accrete, 41 cases (82%) passed their major surgery and recovery period without any reported complications. There were some common complications between the same cases. There was 14% (7 cases) complicated with bladder injury, 8% (4 cases) with fever, also 8% (4 cases) with UTI, 12% (6 cases) wound infection and 10% (5 cases) needed postoperative maternal ICU admission. Neither maternal death, DIC, readmission for any cause nor relaparotomy was reported for any case. Conclusion: The stepwise uterine sparing procedure was successful as a conservative form of surgical management of placenta accrete with preserving the uterus and fertility, saving patient’s life and minimizing major surgical interventions in all patients.
Authors and Affiliations
Doaa Abdelnaby Marey
Keywords
Related Articles
- EP ID EP553841
- DOI 10.17140/ GOROJ-4-142
- Views 151
- Downloads 0
Interactions of Immunomodulatory HLA-G with Immune Cells during Pregnancy and Endometriosis
The Major Histocompatibility Complex (MHC), the genetic region that encodes the proteins responsible for tissue graft rejection,1 encodes MHC Class I (MHC-I) and MHC Class II (MHC-II) glycoproteins. There are two subclas...
Different Uses of Chitosan for Treating Serious Obstetric Hemorrhages
Postpartum hemorrhage is a major cause of maternal death worldwide. Many therapeutic strategies have been developed to reduce maternal morbidity and mortality like oxytocin, prostaglandin, and uterine balloons. A new mem...
High-Throughput Next Generation Sequencing: Applications in Reproductive Diagnosis and Research
The genetic information contained within a cell is transferred through the process of transcription of genes within a genome to produce messenger RNAs (mRNAs) and translation of mRNAs to synthesize proteins. The central...
Analyzing Pregnancy Costs with Finite Mixture Models: An Opportunity to More Adequately Accommodate the Presenceof Patient Data Heterogeneity
The choice of a model in the analysis of patient health care costs and utilization is critical for a clear understanding of the behavior and estimation of quantities like incremental costs or cost-effectiveness. In study...
Nausea and Vomiting in Pregnancy-The Bump in the road of Motherhood
Early pregnancy is commonly associated with nausea and/or vomiting, known by the lay term morning sickness and this can impact the Quality of Life (QoL) of the pregnant woman despite being considered a part of the first...