Could Simple Procedures Minimize Hysterectomy in Management of Placenta Accreta?

Shehata, Ayman; Hussein, Naglaa Ali; Elhalwagy, Ahmed; Gergawy, A El

doi:10.5958/2394-2754.2015.00018.1

Cited by 7 publications

(7 citation statements)

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“…[94,84] Some patients had more than one such procedure. Hospital [95] , but in our study, the success rate was 52.7%, The difference in result may be owing to applying multiple procedures like compression suture and sewing placental bed and local resection of placental implantation site Our study agreed with El Shazly et al and another study. (96,113,114,111) .…”

Section: Discussionsupporting

confidence: 85%

Placenta accreta spectrum: maternal near miss

Kadhim¹,

Flaih²,

Alheidery³

2020

ATMPH

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A randomized prospective surgical case series study Setting: antenatal and labor wards and operative theater at AL-Zahra maternity and pediatric teaching hospital at Al-Najaf city, Iraq (tertiary referral center). Participants: patients admitted through the reception room or outpatient clinic, 198 multiparous women in the third trimester ≥30 wk., all patients had a history of prior cesarean section and all cases with a diagnosis of placenta accreta by Doppler ultrasound and at the surgery.

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Section: Discussionsupporting

confidence: 85%

Placenta accreta spectrum: maternal near miss

Kadhim¹,

Flaih²,

Alheidery³

2020

ATMPH

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“…15 In the present study uterine artery ligation was performed in 300 cases (60.73%). this is in agreement with many authors who advocate routine uterine artery ligation in PA. 16 Another study done at Tanta University Hospital which reported 100% success of double uterine artery ligation in management of PA. 17 Others reported no value for this ligation. 18 Mitwaly and his colleague tried a new method of combined surgical steps in management of PA. 19 It was successful in 18 out of 20 cases for conservation of the uterus with no postpartum hemorrhage or maternal mortality.…”

Section: Discussionmentioning

confidence: 96%

Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt

Zakherah

Abdel-Aziz

Othman

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: The aim of the current study was to estimate the incidence of placenta previa (PP) and accreta (PA) in the period from January 2015 to December 2016 at Women’s Health Hospital, Assiut University, Egypt and to evaluate the maternal and neonatal outcomes.Methods: The study included all cases of PP with or without suspicion of accreta who were diagnosed preoperatively by ultrasound at Women’s Health Hospital, Assiut University. Maternal and neonatal outcomes were evaluated. All intraoperative and postoperative data were reported. The obtained data was analyzed by means of SPSS software (version 22.0) and p<0.05 was taken as the significant level.Results: Total number of deliveries was 29027 cases. The number of cases of PP was 494 cases making an incidence of 1.7%, among them 95 cases were confirmed during surgery to be accreta (0.33%). Uterine artery ligation was carried out 300 cases (60.7%) of cases while cesarean hysterectomy was performed in 56 cases (11.3%). Bladder injury occurred in 58 cases (11.7%), ureteric injury occurred in 6 cases (1.2%), colon injury occurred in 1case (0.2%) and vascular injury occurred in 2 cases (0.4%). Maternal mortality was 4 cases (0.8%). The mean gestational age was 34.73 ± 2.8 weeks. Also, over the two years there were 148 neonatal cases (29.9%) needed assisted ventilation in the form of ambu bag or endotracheal intubation gestation. NICU admission needed in 109 neonatal cases (22.06%) and neonatal mortality reported in 18 neonates (3.6%).Conclusions: The incidence of both PP and PA is very high in our locality due to increase CS rate.

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“…Also there were some different results, such as the units of blood transfusion (2-7) units while in our study (2)(3)(4)(5) units. The operative time was (110±20) minutes, while in our study was (75-140) minutes and the mean hospital stay was (4.2±0.4) days, while in our study was (3)(4)(5)(6)(7)(8)(9)(10)(11) days. Comparing rates of associated complications, one patient had post-operative wound infection while in our study, 6 cases (12%).…”

Section: Discussionmentioning

confidence: 69%

Outcome of Stepwise Uterine Sparing Approach as a Conservative Surgical Management of Placenta Accreta

Marey¹,

Dawood²,

Mostafa³

et al. 2017

Gynecol Obstet Res Open J

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CitationMarey DA, Dawood AS, Mostafa MZ, Salem HA. Outcome of stepwise uterine sparing approach as a conservative surgical management of placenta accreta. 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.

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Could Simple Procedures Minimize Hysterectomy in Management of Placenta Accreta?

Cited by 7 publications

References 0 publications

Placenta accreta spectrum: maternal near miss

Placenta accreta spectrum: maternal near miss

Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt

Outcome of Stepwise Uterine Sparing Approach as a Conservative Surgical Management of Placenta Accreta

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