568 Clap is a new methodic of organ-preserving surgery during caesarean section in pregnant women with abnormally invasive placenta in the scar

Abstract

Aimsto evaluate efficiency of CLAP – a new method of organ-preserving surgery during caesarean section in pregnant women with abnormally invasive placentain the scar (after previous cesarean section). Methods: We offer a new methodic that prevents hysterectomy in women with abnormally invasive placentain the scar. This is an alternative method to the Triple-P procedure, which helps to avoid using special equipment (radiological and endovascular technologies). 15 pregnant women with diagnosed by ultrasound- and MR-imaging “abnormally invasive placentain the scar after previous cesarean section, where 9 of them had a penetration into urinary bladder wall. After prevention of neonatal RDS, these women had caesarean section at 34-35 gestation weeks using our method. CLAP is an abbreviation, that stands for methodic's stages: stage I – C – caesarean section though uterus fundul; stage II – L – ligation of internal iliac arteries; stage III – A – adherent placenta's area excision; stage IV – P – pressure, applied to the lower uterine segment. The 4th stage includes applying of COLUS methodic, draining of uterine cavity with catheter to postoperative blood loss evaluation. Results: In 14/15 cases of adherent placenta CLAP procedure was successful and helped to avoid hysterectomy. In 1 case, use of our methodic was restricted due to placental penetration of cervical canal and massive bleeding - a decision to perform hysterectomy was made. Total blood loss was 2100±200 ml, with adequate transfusion-infusion therapy. All of the patients were successfully discharged from our intitution on 8-10th day. Conclusions: CLAP method is an effective alternative to the Triple-P procedure that helps to avoid hysterectomy and usage of special equipment during caesarean section.