Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure

Abstract

Objectives

Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders

“…Surgical techniques including resection of the invaded myometrium with the placenta are currently the most popular conservative surgical approach . Teixidor Viñas et al . compared the “triple P” procedure with the conventional approach of leaving the placenta in situ and concluded that the former was better with regard to uterine preservation (100.0% vs 72.7%).…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,

“…A novel uterine‐sparing procedure for PAS disorders called the “Triple‐P procedure” was recently proposed . The aim of this procedure is to avoid incising through the vascular placental venous sinuses, and to excise the myometrium with PAS disorder tissue and to reconstitute the uterine defect.…”

“…A comparison of two periods (i.e. before implementation of the Triple‐P procedure [n=11] and after [n=19]) showed no difference in the estimated mean blood loss and rate of transfusion; however, the rates of postpartum hemorrhage and hysterectomy were lower in the Triple‐P procedure group . Larger studies are needed to demonstrate the safety and efficacy of this technique.…”

An update on the risk factors for and management of obstetric haemorrhage

“… 18 A recent study has shown that the Triple P procedure is associated with a statistically significant reduction in PPH and in patient hospitalization. 19 Based on the institutional data, out of 52 cases of Triple P procedures ( Figure 4 ) that have been performed thus far, no cases of peripartum hysterectomies have been performed. This procedure requires the use of prophylactic occlusion balloon catheters within the anterior division of internal iliac arteries and this may not be universally available in low-resource settings.…”