SURGICAL APPROACHES IN MORBIDLY ADHERENT PLACENTA: A COMPARATIVE ANALYSIS OF MYOMETRIAL RESECTION AND CAESAREAN SECTION HYSTERECTOMY

Main Article Content

Dr Humeera Naz
Dr Bakth Ranra
Dr Parveen Shafi
Dr Faiza Naz
Dr Zul-E-Huma
Dr Aneesa Sadiq

Keywords

morbidly adherent placenta, myometrial incision, cesarean section

Abstract

Introduction: Morbidly adherent placentas pose serious health risks, often requiring hysterectomy during caesarean section. Recent research suggests myometrial resection as a potential alternative, especially for women planning future pregnancies, warranting a comprehensive comparison to inform evidence-based surgical strategies.


Objective: To assess the effectiveness and safety of surgical procedures for morbidly adherent placentas, this study will conduct a comprehensive comparative analysis of myometrial excision and caesarean hysterectomy.


Methodology: This prospective observational study was conducted at Bacha Khan Medical Complex from January, 2020 to December, 2022. Fifty people having a history of severe adherent placentas were part of the research group. Group B consisted of 35 patients who had myometrial excision, whereas group A consisted of 15 patients who underwent cesarean hysterectomy. Details regarding the procedure's type (elective or emergency), booking status, blood loss, additional compression sutures needed, post-procedure hospital stay, transfusion requirements, and complications were recorded using a self-created form. SPSS version 23 was used to do the statistical analysis.


Result: The study compared outcomes in two groups (Group A, n=15, and Group B, n=35) undergoing surgical procedures for morbid adherent placentas. Significant differences were observed in age distribution, mode of surgery, booking status, and parity. Clinical measures revealed significant disparities in blood transfusion requirements (p=0.003) but non-significant differences in postoperative hospital stay and gestational age of termination of pregnancy (TOP). Group B exhibited higher incidences of bladder injury, blood loss, re-laparotomy, and postoperative infections, highlighting the need for tailored approaches in managing complications associated with morbid adherent placentas in diverse patient cohorts.


Conclusion: There were less complications after myometrial resection compared to cesarean hysterectomy, including infection, blood loss, bladder damage, and relaparotomies, making it a safer and more reliable option.

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References

1. Clausen C, Lönn L, Langhoff‐Roos J. Management of placenta percreta: a review of published cases. Acta obstetricia et gynecologica Scandinavica. 2014 Feb;93(2):138-43.
2. Palacios‐Jaraquemada, JM. Caesarean section in cases of placenta praevia and accreta. Best Pract Res Clin Obstet Gynaecol. 2013; 27: 221– 32.
3. Palacios, Jaraquemada JM, Pesaresi, M, Nassif, JC, Hermosid, S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004; 83: 738– 44.
4. Clausen, C, Stensballe, J, Albrechtsen, CK, Hansen, MA, Lonn, L, Langhoff‐Roos, J. Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta. Acta Obstet Gynecol Scand. 2013; 92: 386– 91
5. Uysal G, OKÇU NT, Eskimez E, YILMAZ ES. Local resection for placenta accreta spectrum: a conservative uterus sparing technique for anterior placenta accreta. The European Research Journal. 2018;5(1):50-
6. Mahalingam HV, Rangasami R, Premkumar J, Chandrasekar A. Placenta accreta scoring system (PASS) assessment of a simplified clinico-radiological scoring system for antenatal diagnosis of placenta accreta. Egyptian Journal of Radiology and Nuclear Medicine. 2021 Dec;52(1):1-6
7. Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta.Am J Obstet Gynecol 2015;212:561-8
8. Kutuk MS, Ak M, Ozgun MT. Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders. International Journal of Gynecology & Obstetrics. 2018 Mar;140(3):338-44
9. Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstetrics & Gynecology Science. 2021 Mar 24;64(3):239-47
10. Likis FE, Sathe NA, Morgans AK, Hartmann KE, Young JL, Carlson-Bremer D, Schorn M, Surawicz T, Andrews J. Management of postpartum hemorrhage.2015 Apr
11. Karaman E, Kolusarı A, Çetin O, Çim N, Alkış İ, Yıldızhan R, Şahin HG, Gül A. Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital. The Journal of Maternal-Fetal & Neonatal Medicine. 2017 Apr 18;30(8):947-52.
12. Palacios Jaraquemada JM, Garcia Monaco R, Barbosa NE, Ferle L, Iriarte H, Conesa HA. Lower uterine blood supply: extrauterineanastomotic system and its application in the surgical devascularization techniques. Acta Obstet Gynecol Scand 2007; 86:228- 34.
13. Vichinsky, E. P., Haberkern, C. M., Neumayr, L., Earles, A. N., Black, D., Koshy, M., ... & Preoperative Transfusion in Sickle Cell Disease Study Group. (1995). A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. New England Journal of Medicine, 333(4), 206-214.
14. Chandraharan E, Rao S, Belli AM, Arulkumaran S. The TripleP procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet 2012; 117:191- 4.
15. Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: A stepwise approach. Arch Gynecol Obstet 2015;291:993-8.
16. Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstetrical & gynecological survey. 2007;1;62(8):540-7.
17. Puntambekar, S., Gallinat, A., & Stark, M. Hysterectomy: Current Methods and Alternatives.
18. Rathert, Cheryl, Mary D. Wyrwich, and Suzanne Austin Boren. Patient-centered care and outcomes: a systematic review of the literature. Medical Care Research and Review. 2013; 70(4): 351-379.
19. Nair SS, Radhamany K, Nayar J. Morbidly Adherent Placenta: A 7-year experience. Annals of Woman and Child Health. 2016; 2(2):A15-21.

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