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Published online: 2021-03-03
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An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study

Zeyneb Bakacak, Murat Bakacak, Kadir Güzin, Fatih Mehmet Yazar, Aslı Yaylalı, Aytekin Uzkar
DOI: 10.5603/GP.a2020.0155

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2021-03-03

Abstract

Objectives: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes
in treatment strategies and complications according to year.
Material and methods: A retrospective examination was made of 93 patients applied with caesarean hysterectomy with
a diagnosis of placenta percreta in 5-year periods of 2005–2009, 2010–2014, and 2015–2019. Demographic characteristics
were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight.
Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit
(ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement
for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded.
Results: The 93 patients comprised 8 cases in the period 2005–2009, 23 in 2010–2014, and 62 in 2015–2019. The number
of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was
observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was
seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis
of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine
fundal incision were greatest in the period 2015–2019.
Conclusions: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes
can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal
prenatal preparation.

Abstract

Objectives: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes
in treatment strategies and complications according to year.
Material and methods: A retrospective examination was made of 93 patients applied with caesarean hysterectomy with
a diagnosis of placenta percreta in 5-year periods of 2005–2009, 2010–2014, and 2015–2019. Demographic characteristics
were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight.
Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit
(ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement
for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded.
Results: The 93 patients comprised 8 cases in the period 2005–2009, 23 in 2010–2014, and 62 in 2015–2019. The number
of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was
observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was
seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis
of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine
fundal incision were greatest in the period 2015–2019.
Conclusions: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes
can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal
prenatal preparation.

Get Citation

Keywords

placenta percreta; cesarean hysterectomy; prenatal diagnosis; perinatal outcome

About this article
Title

An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-03-03

DOI

10.5603/GP.a2020.0155

Keywords

placenta percreta
cesarean hysterectomy
prenatal diagnosis
perinatal outcome

Authors

Zeyneb Bakacak
Murat Bakacak
Kadir Güzin
Fatih Mehmet Yazar
Aslı Yaylalı
Aytekin Uzkar

References (20)
  1. Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018; 378(16): 1529–1536.
  2. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005; 192(5): 1458–1461.
  3. Bailit JL, Grobman WA, Rice MM, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 2015; 125(3): 683–689.
  4. Silver RM, Clark EAS, Silver RM, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6): 1226–1232.
  5. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997; 177(1): 210–214.
  6. Baldwin HJ, Patterson JA, Nippita TA, et al. Antecedents of Abnormally Invasive Placenta in Primiparous Women: Risk Associated With Gynecologic Procedures. Obstet Gynecol. 2018; 131(2): 227–233.
  7. Irving C. and Hertig AT. A study of placenta accreta. Surg Gynec Obst. 1937; 64: 178–200.
  8. Tabsh KM, Brinkman CR. 3rd, King W. Ultrasound diagnosis of placenta increta. J Clin Ultrasound. 1982; 10(6): 288–290.
  9. Allen L, Jauniaux E, Hobson S, et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet. 2018; 140(3): 281–290.
  10. Eller AG, Porter TF, Soisson P, et al. Optimal management strategies for placenta accreta. BJOG. 2009; 116(5): 648–654.
  11. Di Mascio D, Calì G, D'antonio F. Updates on the management of placenta accreta spectrum. Minerva Ginecol. 2019; 71(2): 113–120.
  12. Mogos MF, Salemi JL, Ashley M, et al. Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011. J Matern Fetal Neonatal Med. 2016; 29(7): 1077–1082.
  13. Klar M, Michels KB. Cesarean section and placental disorders in subsequent pregnancies--a meta-analysis. J Perinat Med. 2014; 42(5): 571–583.
  14. Robinson BK, Grobman WA. Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol. 2010; 116(4): 835–842.
  15. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018; 132(6): e259–e275.
  16. Jauniaux E, Alfirevic Z, Bhide AG, et al. Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019; 126(1): e1–e48.
  17. Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. 2011; 117(2 Pt 1): 331–337.
  18. Lilker SJ, Meyer RA, Downey KN, et al. Anesthetic considerations for placenta accreta. Int J Obstet Anesth. 2011; 20(4): 288–292.
  19. Collins SL, Alemdar B, van Beekhuizen HJ, et al. International Society for Abnormally Invasive Placenta (IS-AIP). Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019; 220(6): 511–526.
  20. Clausen C, Lönn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand. 2014; 93(2): 138–143.

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