open access
Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision
, 1, 2, 3, 4, 5, 6, 1, 789
Affiliations- Samsun Maternity Hospital, a Branch of Training and Research Hospital, Samsun, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, Düzce University, Düzce, Türkiye
- IVF Center, Medicana Samsun International Hospital, Samsun, Türkiye
- Marmara University,School of Medicine,Department of Obstetrics and Gynecology,Pendik Training and Research Hospital, Istanbul, Türkiye
- Department of Obstetrics and Gynecology, School of Medicine, SıtkıKocman University, Mugla, Türkiye
- Department of Obstetrics and Gynecology, Ondokuzmayıs University, Samsun, Türkiye
- Department of Obstetrics and Gynecology, “Veris delli Ponti” Hospital, Scorrano, Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy
- Laboratory of Human Physiology, Phystech Bio Med School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
open access
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.
Keywords
morbidly adherent placenta; pfannenstiel incision; uterine incision; cesarean section; complications
About this articleTitle
Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision
Journal
Issue
Article type
Research paper
Pages
359-364
Published online
2021-03-31
Page views
1388
Article views/downloads
1153
DOI
Pubmed
Bibliographic record
Ginekol Pol 2021;92(5):359-364.
Keywords
morbidly adherent placenta
pfannenstiel incision
uterine incision
cesarean section
complications
Authors
Canan Soyer-Caliskan
Samettin Celik
Alper Basbug
Safak Hatirnaz
Mehmet Guclu
Eren Akbaba
Handan Celik
Salim Guleryuz
Andrea Tinelli
References (22)- Groom K, Paterson-Brown S. Placenta praevia and placenta praevia accreta – a review of aetiology, diagnosis and management. Fetal and Maternal Medicine Review. 2001; 12(1): 41–66.
- Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2015; 42(2): 381–402.
- Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol. 2005; 26(1): 89–96.
- Jauniaux E, Ayres-de-Campos D. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction. Int J Gynaecol Obstet. 2018; 140(3): 261–264.
- Polat I, Yücel B, Gedikbasi A, et al. The effectiveness of double incision technique in uterus preserving surgery for placenta percreta. BMC Pregnancy Childbirth. 2017; 17(1): 129.
- Braun T, Weizsäcker K, Muallem MZ, et al. Abnormally invasive placenta (AIP): pre-cesarean amnion drainage to facilitate exteriorization of the gravid uterus through a transverse skin incision. J Perinat Med. 2018; 47(1): 12–15.
- Garmi G, Salim R. Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta. Obstetrics and Gynecology International. 2012; 2012: 1–7.
- Polat I, Alkis I, Sahbaz A, et al. Diagnosis and management of cesarean scar pregnancy. Clin Exp Obstet Gynecol. 2012; 39(3): 365–368.
- Fujiwara-Arikura S, Nishijima K, Tamamura C, et al. Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series. BJOG. 2013; 120(9): 1144–1149.
- Belfort MA, Shamshirsaz AA, Fox KA. The diagnosis and management of morbidly adherent placenta. Semin Perinatol. 2018; 42(1): 49–58.
- Palacios Jaraquemada JM, Pesaresi M, Nassif JC, et al. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004; 83(8): 738–744.
- Melekoglu R, Celik E, Eraslan S, et al. Conservative management of post-partum hemorrhage secondary to placenta previa-accerta with hypogastric artery ligation and endo-uterine hemostatic suture. J ObstetGynecol Res. 2017; 43(2): 265–271.
- Zuckerwise LC, Craig AM, Newton JM, et al. Outcomes following a clinical algorithm allowing for delayed hysterectomy in the management of severe placenta accreta spectrum. Am J Obstet Gynecol. 2020; 222(2): 179.e1–179.e9.
- Lopes ES, Feitosa FE, Brazil AV, et al. Assessment of Sensitivity and Specificity of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta. Rev Bras Ginecol Obstet. 2019; 41(1): 17–23.
- Wang Y, Gao Y, Zhao Y, et al. Ultrasonographic diagnosis of severe placental invasion. J Obstet Gynaecol Res. 2018; 44(3): 448–455.
- Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992; 11(7): 333–343.
- Stanleigh J, Michaeli J, Armon S, et al. Maternal and neonatal outcomes following a proactive peripartum multidisciplinary management protocol for placenta creta spectrum as compared to the urgent delivery. Eur J Obstet Gynecol Reprod Biol. 2019; 237: 139–144.
- Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand. 2011; 90(9): 1036–1042.
- Wylie BJ, Gilbert S, Landon MB, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units Network (MFMU). Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstet Gynecol. 2010; 115(6): 1134–1140.
- Palacios-Jaraquemada JM. Caesarean section in cases of placenta praevia and accreta. Best Pract Res Clin Obstet Gynaecol. 2013; 27(2): 221–232.
- Kilicci C, Ozkaya E, Eser A, et al. Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta. J Matern Fetal Neonatal Med. 2017; 31(22): 2935–2940.
- Igarashi M. Value of Myomectomy in the Treatment of Infertility. Fertil Steril. 1993; 59(6): 1331–1332.
