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REDUCING BLOOD LOSS IN CESAREAN HYSTERECTOMY FOR MORBIDLY ADHERENT PLACENTA: A CASE-CONTROL STUDY
Abstract Number: T5B-5
Abstract Type: Original Research
Peripartum hysterectomy due to adherent placental disease is rapidly increasing in the United States, as high as 1/300 pregnancies1. These procedures are associated with high risk of massive hemorrhage requiring large volume transfusion, intraoperative complications including damage to adjacent organs, and severe systemic consequences2. Interventions to reduce morbidity and mortality are needed. We have developed a multidisciplinary adherent placental service (MAPs) consisting of providers from Obstetrics, Gynecological Oncology, Diagnostic Radiology, Interventional Radiology (IR), Nursing and Obstetric Anesthesiology to create a structured “MAPs Protocol” as follows:
1) Pre-operative MRI
2) Pre-operative & Intra-operative Ultrasound
3) Cesarean Delivery
4) Post-delivery IR guided gel-foam uterine artery embolization
Assess blood loss between patients following MAPs protocol vs those managed via standard cesarean hysterectomy.
Retrospective case-control analysis of patients with singleton pregnancy undergoing a cesarean hysterectomy for invasive placenta. Data was collected from 10 scheduled cases with post-surgical, path proven invasive placenta. Five patients were managed with standard surgical cesarean hysterectomy (controls). Five others were managed via MAPs protocol. Subjects included in the study were similarly matched to placental pathology. Patients presenting with unstable active hemorrhage were not included in this cohort.
Given the small sample size, we conducted a non-parametric, Wilcoxon ranksum test. A description of the overall data is seen in table 1, demonstrating an absolute reduction of surgical blood loss approaching significance (P = 0.059).
Clinically, our data suggests promising results in terms of overall management in the MAPs protocol patients. Qualitatively, our surgical team has reported improved surgical plane visualization. Quantitatively, this has translated to a reduction in blood loss and blood product administration. Although our study is underpowered at this juncture, we are continuing to use this new methodology for all of invasive placenta patients. We will re-analyze the data at 20 patients as this presents a potential option for management of invasive placental disease.