Combined Uterine Artery Ligation, Segmental Myometrial Resection and Intrauterine Balloon to Control Bleeding from Placenta Previa Accreta during Caesarean Section

Abstract

Background: Morbidity attached placenta [MAP] remain a major surgical problem for obstetricians due to severe hemorrhage and its incidence had been continually increased due to increased rate of cesarean deliveries. Aim of the work: To evaluate the safety and efficacy of a conservative intervention for management of placenta accreta. Patients and Methods: Forty-eight, pregnant females with a confirmed diagnosis of placenta previa accreta had been scheduled for elective cesarean delivery had been included. All females had been screened by full history taking, clinical examination, ultrasound and laboratory investigations. Blood loss, operative time, need for transfusion and need for other surgical interventions represented the main outcome and other complications were documented. Results: The blood loss [ml] ranged between 850 to 1300 ml; the mean values were 1082.29±105.89 ml. The operative time ranged between 60 to 130 minutes; the mean values were 87.92±19.35 minutes. There was significant decrease of post-partum hemoglobin when compared to corresponding pre-partum values [9.29±0.76 vs 10.71±0.54 mg/dl respectively]. Four patients [8.3%] need ICU admission, and nine patients [18.75%] need blood transfusion. However, no patients need further surgical intervention or developed DIC. In addition, no mortality had been reported in the current work. Conclusion: Combined uterine artery ligation, partial segmental myometrial resection and intrauterine balloon as a conservative treatment modality or placenta previa accreta is safe and effective.