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Sequential Surgical Steps for Conservative Management of |
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| รหัสดีโอไอ | |
| Creator | Abo Bakr A. Mitwaly, M.D. |
| Title | Sequential Surgical Steps for Conservative Management of |
| Publisher | PIMDEE Co., Ltd. |
| Publication Year | 2559 |
| Journal Title | Thai Journal of Obstetrics and Gynaecology |
| Journal Vol. | 24 |
| Journal No. | 2 |
| Page no. | 136-140 |
| Keyword | placenta previa, placenta accreta, placenta increta, placenta percretap, morbidlyadherent placenta |
| ISSN | 0857-6084 |
| Abstract | Objective: Cesarean section rates are increasing with associated increase in placenta previaand accreta. Placenta accreta is a major cause of maternal morbidity and mortality. Ourobjective was to evaluate of a new method of combined surgical steps in management of morbidlyadherent placenta (MAP) to face its burden, psychological and marital disintegration if managedby hysterectomy in our low facilities.Materials and Methods: In this case series, we evaluated the use of sequential surgical steps forconservative management of 20 cases of MAP as regard the intra-operative and post-operativeoutcomes in Assiut Women Health Hospital, Egypt from June to December 2014. The sequentialsteps started by perfect dissection of urinary bladder, then delivery of the fetus followed byexteriorization of the uterus and application of 4 ring forceps on both uterine and ovarian vessels.Trial of placenta removal followed by application of two towels in the uterine cavity to achievehemostasis. Ligation of uterine artery bilaterally at double low level. Finally, plication of thefriable lower uterine segment from anterior wall after removal of towels.Results: The mean age of the included women was 29.95?4.8 years. All cases had previousuterine scar and placenta previa. Ten cases (50%) had placenta accreta, 8 cases (40%) hadplacenta increta and 2 cases had placenta percreta. Our procedure was succesfulin all 18 casesof placenta accreta and increta but 2 cases of placenta percreta required hysterectomy.No postpartum hemorrhage in all cases. There were no maternal deaths.Discussion: This new method was favorable in the management of MAP and decreased theincidence of hysterectomy in cases of placenta accreta and increta. |
