Evaluation of a modified “Triple-P” procedure in women with morbidly adherent placenta after previous caesarean section

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To describe a modified “Triple-P” procedure and evaluate its outcome in women with morbidly adherent placenta (MAP) after previous caesarean section (CS).


A retrospective cohort study of 96 women with MAP after CS was recruited with 45 women receiving the modified “Triple-P” procedure as study group and the other 51 cases receiving the conventional managements as the control. The maternal outcomes were compared.


The modified “Triple-P” procedure was described in step by step. Women in study group demonstrated reduction of blood loss, transfusion blood volume and operation time, as well as less hospital days and lower hospitalization cost (P < 0.05). In addition, there was no difference in uterine healing rate, hysterectomy rate, and ICU transferring rate (P > 0.05).


Our modified “Triple-P” procedure for MAP after previous CS maintained the advantages of Chandraharan’s “Triple-P” procedure in preservation of uterus for further fertility, less intraoperative blood loss, shorter hospital stays, and lower hospitalization cost but also advanced in feasibility and convenience during introducing into routine clinical practice.

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We thank the pregnant women and their families who participated in our study. Also thank the support from all staffs in the Department of Obstetrics and Gynecology, Nanfang Hospital, China. This research is supported by the Presidential Foundation of Nanfang Hospital for Young Scientists (2016C043).

Author information

YX Wei data analysis and manuscript writing. YW Cao data collection. YH Yu data analysis. ZJ Wang project development and data analysis

Correspondence to Zhijian Wang.

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The authors declare that they have no conflict of interest.

Ethical approval

The study has ethical approval by the Hospital Ethics Committee of Nanfang Hospital for the use of anonymized patient data for medical research.

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Wei, Y., Cao, Y., Yu, Y. et al. Evaluation of a modified “Triple-P” procedure in women with morbidly adherent placenta after previous caesarean section. Arch Gynecol Obstet 296, 737–743 (2017).

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  • Morbidly adherent placenta
  • Conservative management
  • Previous caesarean section
  • Triple-P procedure
  • Uterine wall reconstruction