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Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation
Abstract Number: S 4
Abstract Type: Original Research
Introduction: Cesarean hysterectomy (CH) is commonly performed in women with placenta increta (PI) or placenta percreta (PP). Although the risk of major hemorrhage is well-known in women with PI and PP (1,2), the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare hematologic, transfusion and perioperative outcomes between women undergoing CH for PI vs. PP.
Methods: After IRB approval, we identified 77 women who underwent CH for PI (n=43) or PP (n=34) from the NICHD MFMU Network Cesarean registry, which sourced data from 19 centers from 1999-2002. Hematologic indices, and rates of transfusion and perioperative morbidity were compared between PI and PP groups. Hematologic and transfusion data included: preoperative Hb and platelet (PLT) count; lowest postpartum Hb and PLT count; intraoperative and postpartum transfusion of RBC, FFP and PLTs. Data presented as n (%), mean (SD), median [IQR]. Students t-test, Mann-Whitney U test and Fishers Exact test were used for between-group analyses; P<0.05 as statistically significant.
Results: Rates of RBC transfusion were high in both PP and PI groups (> 73%), with a non-significantly higher proportion of PP patients receiving 5-8 units or >8 units RBC intraoperatively compared to the PI group (Table). Intraoperative and postpartum rates of FFP and PLT transfusion were less than 42% in both groups (Table). We observed a trend towards a higher incidence of general anesthesia in PP patients vs. PI patients. Compared to PI patients, PP patients had significantly higher rates of cystotomy (P=0.02) and postoperative mechanical ventilation (P=0.03), and non-significantly higher rates of ICU admission, coagulopathy, pulmonary edema, ureteral injury and ARDS (Table).
Discussion: Rates of morbidity in PP and PI patients undergoing CH are high. We observed a trend towards higher rates of RBC transfusion, perioperative morbidity and use of general anesthesia in PP women compared to PI women, which is likely to be related to differences in the degrees of abnormal placentation. For PI and PP patients requiring CH, further research is needed to optimize surgical approaches and establish massive transfusion protocols to reduce hemorrhage and surgical-related morbidities.
Refs: (1) BJOG 2009;116:648-54.(2) Acta Obstet Gynecol Scand 2011;90:1140-6.