Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome)

  • Tehreem Yazdani Combined Military Hospital Okara/National University of Medical Sciences (NUMS) Pakistan
  • Fareeha Zaheer Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Nabila Amin Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Saad Mukhtar Fazaia Medical College Islamabad/National University of Medical Sciences (NUMS) Pakistan
Keywords: Focal resection of the lower uterine segment, Obstetric hysterectomy, Morbidly adherent placenta (MAP).

Abstract

Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta.
Study Design: Quasi-experimental study.
Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020.
Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required.

Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases.
Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity.

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Published
2022-05-01
How to Cite
Yazdani, T., Zaheer, F., Amin, N., & Mukhtar, S. (2022). Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome). PAFMJ, 72(2), 627-31. https://doi.org/10.51253/pafmj.v72i2.5780
Section
Original Articles