The effectiveness of double incision technique in uterus preserving surgery for placenta percreta

Ibrahim Polat,Halil Aslan,Aysun Fendal,Burak Yücel,Ali Gedikbasi

doi:10.1186/s12884-017-1262-3

Ibrahim Polat, Halil Aslan + Show 3 more

Open Access

https://doi.org/10.1186/s12884-017-1262-3

Copy DOI

Abstract

BackgroundPlacenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; however, recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). In this study, we aimed to evaluate the effectiveness and results of the double incision technique.MethodsTwenty-two patients with a diagnosis of placenta percreta who underwent conservative surgery were included. Segmental resection was performed via single incision in ten patients and double incision in twelve patients.ResultsThere was no difference between the patients who underwent segmental resection via single and double incision in terms of age, gravida, number of previous caesarean deliveries, gestational age at delivery, or rate of elective surgeries. The operation time, transfusion requirement, intensive care unit admission, total hospitalization and success of conservative surgery were comparable between the groups.ConclusionsBased on the outcomes of our study, double uterine incision allows for the safe extraction of the foetus during uterus-preserving surgery in patients with placenta percreta without worsening the results compared to single uterine incision.Trial registrationNCT02702024, Date of registration: February 26, 2016, retrospectively registered.

Highlights

Placenta percreta is a life-threatening condition that places patients at risk of massive bleeding
Variants of accrete syndrome (AS) are basically classified into three categories according to the depth of trophoblastic growth: placenta accreta, placenta increta, and placenta percreta (PP; villi penetrate through the myometrium and to or through the serosa)
They were aware of the likelihood of hysterectomy based on the intraoperative findings

Summary

Introduction

Placenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). The presence of an abnormally implanted, invasive, or adhered placenta is called accrete syndrome (AS) [1]. The causes of this phenomenon are the partial or total absence of the decidua basalis and defective development of the fibrinoid layer.

Objectives

Methods

Results

Discussion

Conclusion