Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta

Abstract

An initial fertility conserving surgical procedure is an option in patients with extensive invasive placentation with lesser transfusion requirement and shorter operative time compared to cesarean hysterectomy.

Evidence-based Guidelines for the Management of Abnormally Invasive Placenta: Recommendations From the International Society for Abnormally Invasive Placenta

“…Eleven original publications were found that reported on a variety of local resection techniques, seven were retrospective cohort studies, three prospective studies and 1 review. Only one retrospective cohort study 45 (level 2b evidence), compared planned hysterectomy to local resection and found less bleeding in the local resection group measured as packed RBC transfusion (1.1 units compared with 2.2 units; P<0,05). One retrospective cohort study 46 (level 2b evidence), compared a peripartum local resection technique known as the 'Triple-P' procedure to conservative management leaving the placenta partly or entirely in the uterus.…”

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

“…In a study [20], after controlled ligation of the bleeding vessels in the placental bed or segmental resection of the lower uterine segment (LUS), surgeons re-sutured the LUS to preserve uterus. In another study [21], surgeons performed hysterotomy by upper transverse incision without increase the hysterectomy rates, with no substantial difference in comparison to vertical uterine incision.…”

“…Maternal preferences and the future fertility expectation in such cases drive the surgical team to preserve the uterus by two methods. The first technique is by leaving the placenta in its place (not routinely recommended) and the second is by incising the uterus from the upper area (2-3 cm above the percreta line), partially removing the lower uterine segment and preserving the uterus [20,21].…”

Comparison of conservative and radical surgery in the management of placenta previa percreta

“…[13] Local resection and reconstruction methods have been modified by many authors and have been successfully applied in placenta percreta cases until today. [4,7,10,[14][15][16][17][18] We also applied local resection and reconstruction methods in all cases where we have performed US surgery, and the uterus has been preserved in all of the cases. All of these cases were anterior percreta.…”

“…Apart from these methods, uterine artery ligation, internal iliac artery ligation, uterine tourniquet, uteroovarian ligament ligation, stapler use in hysterotomy, intracavitary suture methods has been applied by several authors to reduce the amount of intraoperative bleeding. [9,12,[14][15][16][17][18] In percreta patients who underwent hysterectomy, Turan et al, Palacious et al and Sumigama et al reported an average amount of bleeding as 1950 ml, 2000 ml and 12,140 ml, respectively. [9,11,13] Acar et al and Donna et al reported the average amount of bleeding in placenta accreta spectrum disorders with US surgery as 1350 cc, 1200 cc, respectively.…”