Innovative Surgical Strategies for Morbidly Adherent Placenta: Optimizing Outcomes and Minimizing Maternal Morbidity
DOI:
https://doi.org/10.51253/pafmj.v75i5.13604Keywords:
Blood transfusion, Hysterectomy, Hemorrhage, Morbidly adherent placentaAbstract
Objective: To analyze maternal outcomes associated with different surgical approaches during cesarean section for morbidly adherent placenta.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Obstetrics & Gynecology Departments of Combined Military Hospital Sialkot, Quetta, Kharian, Rawalpindi, Pakistan from Jan 2015 to Dec 2024.
Methodology: This study analyzed 252 women. Patients underwent five types of surgical intervention at time of cesarean section: bilateral internal iliac artery ligation followed by hysterectomy, hysterectomy followed by bilateral internal iliac ligation, hysterectomy alone, placenta left in situ followed by Injection Methotrexate and bilateral internal iliac ligation followed by myometrial resection. Outcomes assessed included the operative time, number of transfusions, duration of hospital stay, incidence of re-laparotomy and postoperative sepsis.
Results: A total of 252 patients were included. Age group ranged between 26 to 40 years (Mean 34.4±3.3), the gestational age was between 34 to 37 weeks (Mean 35.6±0.94) and the mean BMI was 29.6 Kg/m2±1.9. Bilateral internal iliac ligation followed by hysterectomy was done in 138(54.8%), hysterectomy followed by Bilateral internal iliac ligation in 71(28.2%), hysterectomy in 27(10.7%), placenta left in situ in 2(0.8%) and myometrial resection in 14(5.6%) patients. The median hospital stay was 5 days, patients who did not undergo internal iliac ligation required more transfusions as compared to other surgical approaches (p<0.001)
Conclusion: There is variability in clinical outcomes with different surgical approaches for morbidly adherent placenta during cesarean section. The surgical procedures incorporating bilateral internal iliac artery ligation were associated with reduced intraoperative blood loss and improved outcomes.
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