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

Authors

  • 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

DOI:

https://doi.org/10.51253/pafmj.v72i2.5780

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

01-05-2022

Issue

Section

Original Articles

How to Cite

1.
Yazdani T, Zaheer F, Amin N, Mukhtar S. Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome). Pak Armed Forces Med J [Internet]. 2022 May 1 [cited 2024 Jul. 19];72(2):627-31. Available from: https://pafmj.org/PAFMJ/article/view/5780