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04.01.2019 | Maternal-Fetal Medicine

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt

verfasst von: Ahmed M. Hussein, Ahmed Kamel, Ayman Raslan, Dina M. R. Dakhly, Ali Abdelhafeez, Mohamed Nabil, Mohamed Momtaz

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 3/2019

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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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Titel: Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt
verfasst von: Ahmed M. Hussein
Ahmed Kamel
Ayman Raslan
Dina M. R. Dakhly
Ali Abdelhafeez
Mohamed Nabil
Mohamed Momtaz
Publikationsdatum: 04.01.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 3/2019
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-5027-7

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Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt