The Use of Modified Triple-P Method with Adherent Placenta Long - Term Results

Abstract

At the article we represent the long-term results in 17 women who were operated using the modified technique of the Triple-P procedure with placenta percreta. Research was conducted with help of a specially designed questionnaire for patients and ultrasound examination of the wall uterus, especially of the anterior wall and the edge of postoperative scar. System analysis of literature data on this problem was conducted. preterm delivery before 37 weeks amounted to 82.4% (n=14). There were no cases of perinatal losses. The mean duration of operation was 102, 9±21.2 min (65 to 173), the average intraoperative blood loss-2423, 5±854ml (from 980 to 4,100ml). In the process of the surgery, following its third principle (P)-myometrial excision and reconstruction of the wall uterine we removed a large section of the affected tissue of the anterior wall of the uterus at the location of placenta percreta. The size of these "uterine hernias" varied from 10×6cm to 14×16cm. Due to this excision, the data of anatomical and functional condition of the uterus in post-surgery period presented a great interest to us. In average the duration of hospital stay of patients after the operation was 8.2±1.9days (ranges from 5 to 18). Among the postoperative complications there was reported 1 injure of the bladder, one case of the developed hematometra on the 5th postoperative day, 1 case of postpartum endometritis with antibiotic treatment. Up to the survey all the operated patients mentioned restoration of regular menstrual cycle. 4(23.5%) women reported slightly more abundant menstrual flow, and two patients (11,7%) noted algomenoreya. One patient from time to time suffered from painful and difficult urination, and one patient had some signs of vaginal dysbiosis. 2patients (11,7%) reported some change in the quality of sexual life and the other 2-pain during an intercourse; decreased libido-1 patient (5,8%). KeywordsDuring surgery most patients (15 of 17) have refused to undergo surgical sterilization, though in two cases this surgery was performed. At the same time, 11(64, 7%) patients did not plan future pregnancy, 3(17, 6%) patients replied that they were not sure in their intentions and only 3(17.6%) patients are set up on having children in the future. Despite the high percentage of premature births, there were no significant violations in the future development of their children. In 76.5% of cases (n=13) mothers assessed their child development as successful and 23.6% (n=4) -satisfactory. Duration of breastfeeding averaged 6.0±4.5 months (15 days to 15 months). 3 women continued breastfeeding up to the time of the survey. Complications -up to the sonography investigation -in 94.1% of cases (n=16) the size of the uterus was within normal limits and uterus structure was typical (Figure 2), in one case (5,8%) uterine size had been increased due to the presence of uterine myoma. In 76.4% of cases (n=13) typical postoperative scar on the anterior wall of the uterus was visualized, in 23.5% of the cases (n=4) the scar in the ...

Outcomes of the first 50 patients with abnormally invasive placenta managed using the “Triple P Procedure” conservative surgical approach

“…The authors reported good outcomes and this modified procedure may be useful in centers with no access to interventional radiology . The same authors have subsequently performed 35 surgeries using this procedure and have reported good long‐term outcomes at 24 months after surgery …”

“…19 The same authors have subsequently performed 35 surgeries using this procedure and have reported good long-term outcomes at 24 months after surgery. 20 More recently, a Chinese case series of 45 patients managed using the modified Triple P Procedure applied uterine strangulation instead of pelvic arterial balloon occlusion, with good outcomes 21 and a comparable mean blood loss of 2423 mL 21 and 1078 mL, 19 respectively.…”

Modified Triple P Approach by Gynecologic Oncologist-Led Team for Placenta Accreta Spectrum Improves the Outcome: Non-Randomized Controlled Trial

“…A study from 25 USA hospitals found that the average blood loss was 2000 ml [12]. The amount of blood loss reported from the modified triple P approach was 1440 ml [9]. There are many factors affecting the calculated amount of blood loss other than the accuracy of the method of calculation.…”

“…More recently, the success rate was 84.3% using internal iliac artery ligation combined with endosutures in 38 patients [17]. Using the modified triple P approach in 35 patients achieved success rate of 85.7% [9]. A stepwise approach including multiple steps in 65 patients avoid hysterectomy in 91.5% [18].…”

“…In the modified Triple P approach, ligation of the internal iliac vessels is used instead of embolization. The frequency of hysterectomy in women who had the modified triple P approach was 5/35 (14.28%) [9].…”