Abstract
Purpose
To evaluate the effect of a modified type II radical hysterectomy on maternal morbidities and mortality in cases with abnormally invasive placenta (AIP).
Methods
63 cases with AIP were managed at one of the largest referral centers in Egypt in a prospective study design. This technique entails devascularization of the uterus laterally on both sides and to clamp the uterus at the lowest possible point just below the level of the placenta while sparing the ureters.
Results
The difference between pre- and post-operative hemoglobin was only about 1 gm/dl, and the mean blood loss was 1673 ± 958 ml. There was a significant drop in the post-operative need for blood and blood product replacement, packed red blood cells (p = 0.013), fresh red blood cells (p < 0.001), and plasma units (p = 0.012). Operative time (skin to skin) averaged 190 ± 58.2 min as the technique is slow and utilizes meticulous hemostatic steps. ICU admission was 4.8% with a mean total hospital stay of 8.6 ± 3.6 days. Histopathological examination revealed 58 cases of placenta increta and five percreta cases. We also had 16 bladder injuries (25.4%) and two ureteric injuries, and no maternal mortalities.
Conclusion
This technique reduces maternal morbidity and mortality while performing cesarean hysterectomy for cases with AIP.
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Abbreviations
- AIP:
-
Abnormally invasive placenta
- PAS:
-
Placenta accreta spectrum
- PRBCs:
-
Packed red blood cells
- RBCs:
-
Red blood cells
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Acknowledgements
We would like to thank Dr. Hesham Torad M.D. (team’s on-call urologist), and Dr. Ahmed Hosny M.D. (team’s on-call vascular surgeon) for their hard work and continuous support throughout the duration of the study, and for their skills and dedication during the operative procedures when called upon.
Funding
This research did not receive any specific grant from any funding agency in the public, commercial or nonprofit sector.
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AMH: Protocol/project development, obstetrics and gynecological surgery, data analysis, manuscript writing/editing. AK: Protocol/project development, obstetrics and gynecological surgery, data analysis, manuscript writing/editing. AR: Obstetrics and gynecological surgery, data collection or management, manuscript writing/editing. DMD: Obstetrics and gynecological surgery, data collection or management, manuscript writing/editing. AA: Obstetrics and gynecological surgery, data collection or management, manuscript writing/editing. MN: Obstetrics and gynecological surgery, data collection and management, data analysis, manuscript writing/editing. MM: Obstetrics and gynecological surgery, data analysis, manuscript writing/editing.
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404_2018_5027_MOESM67_ESM.mov
Video 4: Demarcation of the level of placenta and clamping just below it. Videos 1 and 2 were filmed by A.K, videos 3 and 4 were filmed by M.N (MOV 8193 kb)
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Hussein, A.M., Kamel, A., Raslan, A. et al. Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt. Arch Gynecol Obstet 299, 695–702 (2019). https://doi.org/10.1007/s00404-018-5027-7
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DOI: https://doi.org/10.1007/s00404-018-5027-7