Anterior placenta percreta: surgical approach, hemostasis and uterine repair.

Abstract

To describe an accurate approach, hemostatic procedures and uterine repair in patients with anterior placenta percreta. A total of 68 patients with anterior placenta percreta were included. A large retrovesical and parametrial dissection was performed in all cases. Hemostasis was achieved with selective vascular ligature or with surgical myometrial compression. The anterior wall defect was repaired using a myometrial suture, fibrin glue and polyglycolic mesh. Finally, a nonadherent cellulose layer was applied over this reconstruction. Hysteroscopy and T2 magnetic resonance imaging (MRI) were performed as a reconstruction control at 90 days after discharge. Elective surgery was performed in 49 patients and emergency surgery in 19. In 59 midline incisions were performed and in nine lower transverse incisions. Forty-nine patients underwent fundal hysterotomy and 19 transplacental segmental uterine approaches. The uteri of 50 patients with anterior placenta percreta were repaired. Of the 18 hysterectomies performed in this series, 16 were indicated due to massive destruction and two were secondary to coagulopathies. The following surgical complications developed: pelvic hemorrhage (one), coagulopathies (two), uterine infection (three), low ureteral ligations (two), iatrogenic foreign bodies (two) and collection (three). Uterine conservation was highly significant between the upper and lower invasion areas. Ten pregnancies were reported after the repair, resulting in uncomplicated cesarean delivery. This approach has allowed an adequate uterine repair in patients with anterior placenta percreta. Based on these results it is valid to assume that a functional and anatomic uterine repair has been successfully performed.