Could Simple Procedures Minimize Hysterectomy in Management of Placenta Accreta?

Abstract

Introduction: The incidence of placenta accreta (PA) is rising as a consequence of increased number of cesarean sections and advancing maternal age, both being independent risk factors. Severe postpartum hemorrhage (PPH) is a leading direct cause of maternal morbidity and mortality. Major surgical interventions like Hysterectomy, ligation of major pelvic vessels and massive blood transfusions are required to save the maternal life. Patients Methods: Fifteen cases of PA were included in the period from August 2014 to may 2015 in Obstetrics and Gynecology Department diagnosed by US and MRI. Preoperative evaluation and Laboratory investigations were done and Cross matched blood were done. Three step simple procedure was applied to all these 15 cases and we assessed its success in minimizing hysterectomy and ligation of major vessels. The procedure include first step: double ligation of uterine artery on both sides before and after placental removal, second step suturing the placental bed and third step is insertion of triple way catheter through the cervix and inflation to 50 cc saline to compress and drain bleeding. Results: The 3 step procedure was successful in minimizing major surgical interventions in all patients because neither patients required hysterectomy nor need Vascular interventions at all. There were no need for massive blood transfusions maximum of 3 -4 units of blood and the need of FFP was limited to 4 cases (26.6%) Complications were present in 6 cases (40%) and were: 2 cases (13.3%) of Bladder injury and 2 cases (13.3%) of pyrexia, 1 case (6.66%) of pyometria and 1 case (6.66%) of wound disruption. Conclusions: Three step procedure is a simple procedure and successful in minimizing major surgical interventions in PA management. Keywords: Placenta, accreta, management