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The Triple‐P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta
Author(s) -
Chandraharan Edwin,
Rao Sridevi,
Belli AnnaMaria,
Arulkumaran Sabaratnam
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2011.12.005
Subject(s) - medicine , placenta percreta , hysterectomy , placenta , hysterotomy , placenta diseases , surgery , placenta accreta , perioperative , maternal morbidity , obstetrics , pregnancy , tamponade , fetus , genetics , biology
The reported maternal mortality for morbidly adherent placenta ranges from 7% to 10% worldwide. Current treatment modalities for this potentially life‐threatening condition include radical approaches such as elective peripartum hysterectomy with or without bowel/bladder resection or ureteric re‐implantation (for placenta percreta infiltrating these organs), and conservative measures such as compression sutures with balloon tamponade and the placenta remaining in situ. However, both conservative and radical measures are associated with significant maternal morbidity and mortality. The present article describes the Triple‐P procedure—which involves p erioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; p elvic devascularization; and p lacental non‐separation with myometrial excision and reconstruction of the uterine wall—as a safe and effective alternative to conservative management or peripartum hysterectomy.