7, 9, 12 Internal iliac artery ligation can be an effective way to control hemorrhage and preserve the uterus, but may be technically challenging in urgent settings. When these methods fail in effective management, other uterine sparing surgical procedures are used, which include uterine compression sutures, uterine arterial embolization, and ligation of the uterine or hypogastric artery. Postpartum hemorrhage is primarily managed with the help of conservative approaches such as using uterotonic agents, bimanual uterine massage as well as laceration suturing. 11 However, many women desire fertility-sparing surgery, if possible, for which several conservative methods have been adopted. 10 In around 75% of cases with morbidly adherent placenta previa, peripartum hysterectomy is preferred. Peripartum emergency hysterectomy is the most effective and safe intervention to stop postpartum hemorrhage. 8 Several predictive models were developed to assess the outcomes of placenta accreta spectrum and uterine sparing techniques. 2, 7 It is also one of the common causes of maternal mortality with a mortality incidence of 7% worldwide. 5, 6 The massive hemorrhage often leads to multiorgan failure and the need for morbid hysterectomy and blood transfusion. The management of morbidly adherent placenta previa is challenging due to the high risk of massive hemorrhage following delivery due to invasion of the placenta into surrounding tissues in those with placenta percreta. A recent retrospective study reported that the rate of accreta for previous 1, 2, 3, 4, and 5 cesarean deliveries was found to be 26.7%, 43.5%, 65.5%, 55.6%, and 66.7, respectively. 4 The number of previous cesarean deliveries is the most important antenatal risk factor. 3 The increase in the incidence is attributed to increase in cesarean deliveries from 1 in about 2500 births to 1 in 500 births. 1, 2 The incidence of morbidly adherent placenta increased in the past decade from 0. Placenta accreta spectrum or morbidly adherent placenta occurs mostly on a previous cesarean scar when placenta fails to detach due to abnormal invasion of placenta in to the uterine wall. Keywords: morbidly adherent placenta previa, spiral suture, lower uterus, aortic balloon occlusion No major catheterization-related and postpartum complications were observed.Ĭonclusion: Fertility-sparing surgery for women with morbidly adherent placenta could include abdominal aortic balloon occlusion and spiral suture of lower uterine segment. One patient experienced surgery-related complications, a bladder injury. Fetal and maternal radiation doses were 5 mGy and 12 mGy, respectively. Median abdominal aortic balloon occlusion time was 17 minutes. Of 53 patients who required blood transfusions, the amount of packed red blood cells given was 800 mL and the amount of plasma given was 400 mL. Hysterectomy was performed in three patients and uterine artery embolization in 21 patients.
Results: A total of 68 patients underwent surgery. Perioperative blood loss, hysterectomy rate, amount of blood transfusion, balloon occlusion time, fetal and maternal radiation dose, and postpartum complications were assessed. Bilateral uterine artery embolization was performed, to control excessive bleeding. The study considered 68 cases of morbidly adherent placenta previa cases from medical records retrospectively with age ranging from 23 to 42 years.
Patient and Methods: This retrospective, single-center study involved patients from 2017 to 2020. Purpose: We aimed to investigate the combined effect of spiral suture of the lower uterine segment with intraoperative aortic balloon occlusion in morbidly adherent placenta previa cases. Yin Yin, 1 Lin Qu, 1 Bai Jin, 1 Zhengqiang Yang, 2 Jinguo Xia, 2 Lizhou Sun, 1 Xin Zhou 1ġDepartment of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People’s Republic of China 2Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People’s Republic of ChinaĬorrespondence: Xin Zhou, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People’s Republic of China, Tel +86 25 8620 0133, Fax +86-25-8371-6602, Email a.com
0 kommentar(er)
