Abstract
Objective To evaluate current morbidity and mortality in patients with uterine atony and placenta accreta, using various treatments introduced in recent years in a single institution. Materials and methods A retrospective analysis was conducted in 143 pregnant women with uterine atony (n=70) and placenta accreta (n=73) admitted to the intensive care division from March 1991 to February 2008. Results Fifty-five patients (38.4%) had hemorrhagic shock and 47 (32.8%) had coagulation factor defects. The mean red cell transfusion requirement was 4.7±4.2 units. Sixty-six patients underwent hysterectomy as the last choice to stop massive bleeding. From 2002, several novel surgical techniques were used: uterine compression sutures (n=18), uterine artery ligations (n=15) and surgical uterine repair in patients with placenta percreta (n=17). In 31 patients, embolization of the uterine arteries was performed as treatment and prevention of massive hemorrhage, reducing morbidity and significantly increasing uterine conservation. All 143 puerperal women survived without sequelae. Conclusions Incorporation of new surgical techniques and embolization of the uterine arteries was associated with a significant decrease in the prevalence of hysterectomies, lower postoperative morbidity and optimal maternal survival.
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