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Maternal Outcomes following delayed hysterectomy for placenta accreta compared to peripartum hysterectomy
Abstract Number: T-19
Abstract Type: Original Research
The rising rate of Cesarean delivery has resulted in an associated increase in the incidence of abnormally adherent placenta1. Placenta accreta is associated with dramatic massive hemorrhage, which can result in disseminated intravascular coagulation, multiple organ dysfunction and death. It is not uncommon that a hysterectomy is needed to stop the hemorrhage and is one of the commonest indications for cesarean hysterectomy in developed countries.
Peripartum hysterectomies associated with placenta accreta are associated with higher risk of complications. Leaving the placenta in-situ avoids immediate massive hemorrhage, prevents damage to surrounding tissues and a hysterectomy can be done electively at a later date. The purpose of this study was to review our experience in the management of placenta accreta and evaluate if this strategy is associated with reduced maternal morbidity.
Parturients with placenta accreta that delivered between 01/01/1993 and 02/01/2011 were identified. The medical records were then reviewed and abstracted for demographic data, obstetric history, medical history, hospital course, and maternal outcomes. Outcomes were compared according to patients who had peripartum hysterectomy and those who had delayed hysterectomy at 4-6 weeks postpartum. Descriptive statistics is used to describe the cohort of patients.
47 cases of placenta accreta were identified between January 1993 and February 2011. However in 15 parturients the medical records were incomplete and 2 parturients had uterine conservation management. Demographic and clinical characteristics of the 30 parturients included in study are summarized in table 1.
The peripartum management is summarized in table 2. 80% of women in the delayed hysterectomy group had radiological interventions to prevent or control hemorrhage.Maternal morbidity is summarized in table 3.
A multidisciplinary team was involved in the management of these women. The overall morbidity in this cohort was 40%, though high is consistent with recently published data. There was no significant statistical difference in patients in the 2 groups. However it may be clinically significant considering that the peripartum hysterectomy group was twice more likely to require ICU admission, need > 4 units of packed red cells and develop coagulopathy
Obstet. Gynecol. 2006;107:927-41.
Am. J. Obstet. Gynecol. 1997;177:210-4
Obstet. Gynecol. 2011;117:331-7