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Published online: 2021-03-31
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Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Canan Soyer-Caliskan, Samettin Celik, Alper Başbuğ, Safak Hatirnaz, Mehmet Guclu, Eren Akbaba, Handan Celik, Salim Güleryüz, Andrea Tinelli
DOI: 10.5603/GP.a2020.0192
·
Pubmed: 33844256

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2021-03-31

Abstract

Objectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate
because of repeated cesarean sections (CS).
The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating
the maternal fetal impact of the two methods.
Retrospective multicentric cohort study.
Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one,
comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower
uterine segment (LUS) incision (transverse-transverse), which was 2–3 cm above the MAP border, with the uterus in the
abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal
incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus
till the border of the MAP.
Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative
complications were investigated.
Results: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group
2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively
(p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte
suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008,
p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.
Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less
blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of
surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.

Abstract

Objectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate
because of repeated cesarean sections (CS).
The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating
the maternal fetal impact of the two methods.
Retrospective multicentric cohort study.
Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one,
comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower
uterine segment (LUS) incision (transverse-transverse), which was 2–3 cm above the MAP border, with the uterus in the
abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal
incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus
till the border of the MAP.
Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative
complications were investigated.
Results: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group
2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively
(p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte
suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008,
p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.
Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less
blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of
surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.

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Keywords

morbidly adherent placenta; pfannenstiel incision; uterine incision; cesarean section; complications

About this article
Title

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-03-31

DOI

10.5603/GP.a2020.0192

Pubmed

33844256

Keywords

morbidly adherent placenta
pfannenstiel incision
uterine incision
cesarean section
complications

Authors

Canan Soyer-Caliskan
Samettin Celik
Alper Başbuğ
Safak Hatirnaz
Mehmet Guclu
Eren Akbaba
Handan Celik
Salim Güleryüz
Andrea Tinelli

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