Abstract
Introduction: Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. The ideal conservative management still does not exist. We aimed to compare the outcome of cesarean section for PAS by a gynecologic oncologist-led team using the modified triple P approach and by a non-gynecologic oncologist-led team. Material and Methods: This is non-randomized controlled trial. Group A had Cesarean Section by gynecologic oncologist. Gynecologic oncologist-led team did all Cesarean Section following a modified triple P approach. The first P is for “Plan” the uterine incision. The second P for “Pelvic” devascularization by internal iliac artery ligation. The third P is for Placenta non-separation with resection of the myometrium. Group B had Cesarean Section by non-gynecologic oncologist-led team. The main outcome measures were the need for hysterectomy, amount of blood loss, and the management-related complications. Results: Group A had significantly less estimated blood loss, and received less number of backed RBCs units, and less operative time than group B. The uterus is preserved in all cases of group A and in 50% of cases of group B. The overall maternal morbidity rate was 17.5% in group A and 72.2% in group B. Conclusion: This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team.
Highlights
Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality
This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team
Preoperative suspected PAS based upon Doppler ultrasound and real-time three D ultrasound is found in 84 cases
Summary
Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. We aimed to compare the outcome of cesarean section for PAS by a gynecologic oncologist-led team using the modified triple P approach and by a non-gynecologic oncologist-led team. Gynecologic oncologist-led team did all Cesarean Section following a modified triple P approach. Group B had Cesarean Section by non-gynecologic oncologist-led team. Conclusion: This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team. Placenta Accreta Spectrum (PAS) is an abnormally adherent placenta to the myometrium [1] It is a major cause of maternal mortality and morbidity [2]. The diagnosis of PAS is based on the failure of the placenta to separate after delivery of the baby by the usual gentle traction or evidence of visible myometrial invasion at time of surgery. The Royal College of Obstetricians and Gynecologists (RCOG) recommend delivery not before 36 - 37 weeks [7]
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