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Article Type

Original Study

Abstract

Background Placenta accreta (PA) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management nowadays owing to increased incidence of PA in parallel with the increased cesarean section rates. With the age of the patients with PA getting younger and fertility preservation being required, until now, there is no unique approach to management of PA. Objective The purpose of this study was to describe the efficacy and safety of different surgical procedure in conservative treatment of PA to evaluate their role in minimizing major surgical intervention, especially hysterectomy with its comorbidities. Patients and methods This prospective, surgical case-series study included 49 consecutive patients with PA who were prenatally diagnosed by ultrasound or MRI at the Department of Gynecology and Obstetrics of Shebin El-Kom Teaching Hospital (Menoufia, Egypt) from August 2012 to July 2017, and informed consent was obtained from all participants before surgery. We recorded demographic profile, obstetric characteristics of patients, operative parameters of patients, and surgical outcomes. Results In this 5-year period, among 12 250 deliveries, only 49 patients met the diagnostic criteria of placenta accrete (4/1000). In our study group, the patients’ mean age at delivery was 30.45 (5.5) years, and their mean BMI was 28.5 (2.5). Overall, 33 patients were scheduled for cesarean section and 16 patients were emergency cesarean cases owing to active bleeding or labor. In 12 (24.49%) patients in this study, the attempts of delivery by cesarean plus different surgical techniques failed because of immediate heavy bleeding originating from cervix that necessitated emergent hysterectomy as a life-threating condition. The rate of successful uterine preservation was high (77.27%) in uterine artery ligation and internal iliac artery ligation, 70% in uterine artery ligation and ovarian artery ligation, and 70% in Shehata's simple procedure, but low in modified B-lynch suture (40%) and in one-step procedure (50%). Maternal mortality rate was 2.04%, including one maternal death. Conclusion Our surgical approaches are effective and successful in minimizing major surgical interventions especially hysterectomy with its comorbidities in PA management. Nevertheless, the best policy remains a matter of debate.

Keywords

Cesarean hysterectomy, maternal outcomes, placenta accreta, surgical techniques

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