Local resection for placenta accreta spectrum: a conservative uterus sparing technique for anterior placenta accreta

Year 2019, , 50 - 57, 04.01.2019

Gülsüm Uysal , Nefise Tanrıdan Okçu , Eda Eskimez Esra Saygılı Yılmaz

https://doi.org/10.18621/eurj.382390

Cited By: 1

Abstract

Objective: To evaluate and describe a surgical approach for
uterine preservation and management of postpartum hemorrhage in placenta
accreta spectrum (PAS).

Methods: We analyzed the data of
patients who were diagnosed with placenta previa companied with PAS prenatally
and subsequently performed cesarean section with local resection technique to
manage postpartum hemorrhage and uterine preservation at our tertiary care
center between January 2016 and August 2017. The technique includes the local
resection of placental invasion site and suturing the new uterine edges without
internal iliac artery ligation.

Results: The diagnosis of placenta
accreta spectrum anterior in all 11 cases was confirmed intraoperatively. Only
1 case underwent hysterectomy in a second operation. Two of cases had bladder
injury. The mean operative time was 99 ± 30 minutes. The mean received packed red
blood cells was 2.3 ± 1.0 units. The mean length of postoperative hospital stay
was 4.5 ± 1.4 days. There was no late complications regarding coagulopathy and infection.
No maternal mortality was observed.

Conclusion: Local resection is an
effective, safe and fertility preserving approach in selected patients with
PAS. 

Keywords

Placenta accreta spectrum, maternal morbidity, fetal outcome, fertility preservation, uterus preserving surgery, local resection

References

• [1] Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192:1458-61.
• [2] Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, et al. Conservative management of morbidly adherent placenta: expert review.Am J Obstet Gynecol 2015;213:755-60.
• [3] Kutuk MS, Ak M, Ozgun MT. Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2018;140:338-44.
• [4] Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta.Am J Obstet Gynecol 2015;212:561-8.
• [5] Imudia AN, Awonuga AO, Dbouk T, Kumar S, Cordoba MI, Diamond MP, et al. Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experiencefrom a single institution. Arch Gynecol Obstet 2009;280:619-23.
• [6] Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014;121:62-70.
• [7] Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol 2012;120:207-11.
• [8] Jeremiah M. Fecundity, Barrenness and the importance of motherhood in two Nigerian plays. Int J Humanit Soc Sci 2014;4:213-21.
• [9] Clausen C, Lonn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 2014;93:138-43.
• [10] Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand 2004;83:738-44.
• [11] Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet 2012;117:191-4.
• [12] Shabana A, Fawzy M, Refaie W. Conservative management ofplacenta percreta: a stepwise approach. Arch Gynecol Obstet 2015;291:993-8.
• [13] Lin K, Qin J, Xu K, Hu W, Lin J. Methotrexate management for placenta accreta: a prospective study. Arch Gynecol Obstet 2015;291:1259-64.
• [14] Hequet D, Morel O, Soyer P, Gayat E, Malartic C, Barranger E. Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placenta accreta. Aust N Z J Obstet Gynaecol 2013;53:580-3.
• [15] Karaman E, Kolusarı A, Çetin O, Çim N, Alkış İ, Yıldızhan R, et al. Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital. J Matern Fetal Neonatal Med 2017;30:947-52.
• [16] Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol 2010;203:430-9.
• [17] Palacios Jaraquemada JM, Garcia Monaco R, Barbosa NE, Ferle L, Iriarte H, Conesa HA. Lower uterine blood supply: extrauterineanastomotic system and its application in the surgical devascularization techniques. Acta Obstet Gynecol Scand 2007;86:228-34.
• [18] Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysisof risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011;284:47-51.
• [19] Yeniel AO, Ergenoglu AM, Itil IM, Askar N, Meseri R. Effect of placenta previaon fetal growth restriction and stillbirth. Arch Gynecol Obstet 2012;286:295-8.