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Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple‐P procedure
Author(s) -
Teixidor Viñas M.,
Belli A. M.,
Arulkumaran S.,
Chandraharan E.
Publication year - 2015
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.14728
Subject(s) - medicine , hysterectomy , placenta accreta , placenta previa , placenta , blood loss , surgery , pregnancy , obstetrics , uterus , fetus , biology , genetics
Abstract Objectives To evaluate patient outcomes and need for further interventions in women with a morbidly adherent placenta ( MAP ), before and after introduction of the Triple‐P procedure involving placental non‐separation, myometrial excision and reconstruction of the uterine wall. Methods Between December 2007 and February 2014, 30 patients with MAP were treated at our center. In 2007, we instituted a policy of bilateral prophylactic occlusion balloon catheter placement in both internal iliac arteries followed by Cesarean section with non‐placental separation and preservation of the uterus. In 2010, the surgical technique was modified and the Triple‐P procedure introduced. As a result, 19 women in our study received the Triple‐P protocol (study group) and 11 did not (control group). The quantity of blood replacement products, estimated blood loss, and necessity for uterine arterial embolization and/or hysterectomy were recorded retrospectively and compared between the two groups. Results Placenta percreta was confirmed in six (54.5%) patients in the control group and 13 (68.4%) in the study group. Estimated mean blood loss during the procedure was lower in the study group than in the control group (1.70 L vs 2.17 L, respectively), but the difference was not statistically significant ( P = 0.445). The risks of postpartum hemorrhage ( PPH ) and hysterectomy were statistically significantly lower in the study group ( PPH , 54.5% vs 15.8%; P = 0.035; hysterectomy, 27.3% vs 0.0%; P = 0.045). As a consequence, there was a significant decrease in duration of inpatient stay in the study group ( P = 0.044). Conclusion Introduction of the Triple‐P procedure conveyed a significantly reduced rate of hysterectomy, PPH and duration of hospital stay in patients with MAP . Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.